Podiatry Coding & Billing Alert

Hint: Watch out for strapping and restorative treatment on same anatomic area.

As a coder, you already know you must stay up-to-date with the National Correct Coding Initiative (CCI) edits, to submit clean claims in your practice. However, if you neglect to brush up on what the NCCI Policy Manual for Medicare Services says about podiatry services, you could be jeopardizing your claims by missing valuable instructions.

CMS updates the manual annually, and it’s important for coders to become familiar with and to check each year for any revisions or additions in coding edits, explains Theresa Dix, CCS-P, CPMA, CCC, ICDCT-CM, a coder and auditor from Knoxville, Tennessee. Doing this will help coders avoid coding and billing errors. And, in turn, a clean claim will go out the door.

“It is essential for coding and billing staff to stay up-to-date on the CCI edits unique to the specialty area they work in,” adds Cynthia A. Swanson, RN, CPC, CEMC, CHC, CPMA, senior manager of healthcare consulting for Seim Johnson in Omaha, Nebraska. “To thoroughly understand the background and principles of correct coding, the most current version of the NCCI Policy Manual for Medicare Services can be a beneficial tool.”

Bust three common myths relating to fractures, dislocations, casting, splinting, and strapping to ensure you protect your podiatry practice’s bottom line.

Myth 1: If Same Podiatrist Performs Casting Application, Can Also Report Repair Code

Reality: You can only report subsequent repair or removal codes 29700 (Removal or bivalving; gauntlet, boot or body cast) through 29750 (Wedging of clubfoot cast) along with the application of an external immobilization device such as casting, splints, or strapping if a different entity performs the two services, according to the manual. If the same entity performs both the application and the removal or repair services, you can only report the code for the application of the external immobilization device.

Don’t miss: The manual defines an “entity” as a physician, practice, group, employee, etc.

You must remember that the addition of casting or strapping must be done on a separate visit or on a day different from the surgical date if the surgery is performed to repair a fracture or deformity, adds Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Coding scenario: Dr. Lucy Smith performs the initial application of a clubfoot cast (29450, Application of clubfoot cast with molding or manipulation, long or short leg). At a follow-up visit, Dr. Smith also performs a 29750 (Wedging of clubfoot cast) service. By following the instructions in the manual, you can see that since the same provider, Dr. Lucy Smith, performed both the application of the cast (29540) and the repair (29750), you can only report 29540 appropriately.

Myth 2: Can Bill for Both Strapping and Restorative Treatment on Same Anatomic Area

Reality: You cannot report casting, splinting, or strapping separately, “if a restorative treatment or procedure to stabilize or protect a fracture, injury, or dislocation and/or afford comfort to the patient is also performed,” according to the manual.

For example, you cannot report debridement codes like 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) through +11047 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)) along with a casting, splinting, or strapping code for the same anatomic area.

Coding scenario: The podiatrist sees the patient and upon examining her feet, he notes that the patient has a right midfoot non-pressure ulcer with necrosis of muscle. The podiatrist documents a diagnosis of a midfoot non-pressure ulcer — L97.413 (Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle).

To treat the ulcer, the podiatrist performs a debridement service (11043, Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less). The podiatrist also applies an Unna boot (29580, Strapping; Unna boot) to the patient’s ulcer.

For this service, you can only report the debridement service (11043) not the Unna boot application (29580), per the manual’s instructions.

Myth 3: You Can Never Report E/M Code With a Splinting Code

Reality: If the podiatrist “treats a fracture, dislocation, or injury with a cast, splint, or strap as an initial service without any other definitive procedure or treatment and only expects to perform the initial care, then he can report an evaluation and management (E/M) service; a casting, splinting, or strapping CPT^® code; and a casting, splinting, or strapping supply code (Q4001-Q4051),” according to the manual.

Coding Scenario: A 60-year-old new female patient visits the office after falling off a five-step ladder. After a level-two E/M service and some radiology exams, the podiatrist diagnoses the patient as having a closed fracture of the astragalus on her left foot. The podiatrist treats the swelling by applying a plaster-molded splint to immobilize and to protect the fracture. Then, the podiatrist refers the patient to an orthopedic clinic for follow-up treatment in two days.

The CPT^® and HCPCS codes you should report are as follows:

• 29515 (Application of short leg splint (calf to foot)) with modifier LT (Left side) appended to 29515 to show that the podiatrist performed the procedure on the left foot
• 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making…) for the E/M service and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99202 to show the E/M and splinting were separate services
• A HCPCS code in the Q4XXX series for casting supplies.