Podiatry Coding & Billing Alert

Hint: Fracture and dislocation procedure codes include the initial casting, strapping, or splinting.

You know how important it is to stay up-to-date with the National Correct Coding Initiative (CCI) edits. However, even if you are aware of the CCI edits, but neglect to consult the NCCI Policy Manual for Medicare Services, you could still risk incorrectly submitting your podiatry claims.

Take a look at the following FAQs to make sure you know how the CCI Policy Manual answers the podiatry questions you most need answering.

Don’t Report Multiple Fracture/Dislocation Repair Codes for Same Anatomic Site

FAQ 1: If the podiatrist performs fracture or dislocation repair, can we report multiple closed repair, percutaneous repair, or open repair codes for the same anatomic site?

Answer: No. When the podiatrist repairs a fracture or dislocation, you can only report one fracture or dislocation repair code, according to the manual.

Rationale: Since closed repair codes, percutaneous repair codes, and open repair codes for the same anatomic site are considered mutually exclusive of one another, you should report only one code for the repair of a fracture or dislocation at an anatomic site.

Heed This Manual Traction and Compression System Rule

FAQ 2: The podiatrist applied a multi-layer compression system to the patient’s left foot. In the same encounter, he also performed manual traction for 15 minutes in the same anatomic region as he applied the compression system. Can we separately report the manual traction?

Answer: No. Manual traction is considered a manual therapy technique, represented by 97140 (Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes), as you can see by the examples include in the code descriptor. You should not separately report any type of manual therapy during the same patient encounter in the anatomic region where the podiatrist applies a multi-layer compression system, according to the manual.

Rationale: Since 29581 (Application of multi-layer compression system; leg (below knee), including ankle and foot)) includes manual therapy in the anatomic region of the multi-layer compression system, you cannot separately report 97140.

Fracture Repair Procedures Include Initial Strapping

FAQ 3: The podiatrist used a multi-layer venous wound compression system to stabilize the patient’s medial malleolus fracture. The podiatrist performed closed treatment, without manipulation on the fracture. Can we separately report the strapping code (29581) along with the ankle fracture repair code (27760)?

Answer: No. If the podiatrist stabilizes the patient’s ankle fracture or dislocation repair with strapping, you cannot report an ankle fracture repair code such as 27760 (Closed treatment of medial malleolus fracture; without manipulation) along with a strapping code like 29581 (Application of multi-layer compression system; leg (below knee), including ankle and foot). This holds true “even if the strapping simultaneously treats another problem such as edema or a venous stasis ulcer,” according to the manual.

Rationale: Fracture and dislocation procedure codes include the initial casting, strapping, or splinting.

Only Report Open Reduction and Fracture Treatment in This Case

FAQ 4: My podiatrist attempted to perform a closed reduction procedure, but this attempt failed. He then converted the closed reduction to an open reduction during the same patient encounter. Can we report both the closed and open reductions?

Answer: No. If your podiatrist attempts a closed reduction, but the procedure fails and he converts the closed reduction to an open reduction during the same patient encounter, you can only report the open reduction procedure code.

Also, if the podiatrist attempts a closed fracture treatment procedure, but it fails, so he converts the closed fracture treatment to an open fracture treatment during the same patient encounter, you can only report the open fracture treatment procedure.