Podiatry Coding & Billing Alert

Question: Our podiatrist recently stood in as an assistant physician for a severely wounded accident victim. The primary procedure was debridement. How should I code for this scenario?  

Ohio Subscriber

Answer:  The available CPT® codes for debridement procedure is 11043 (Debridement, muscle and/or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; first 20 sq cm or less) and 11046 (Debridement, muscle and/or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; each additional 20 sq cm, or part thereof [List separately in addition to code for primary procedure]). CPT® has a provision for a modifier AS (Assistant surgeon) for some procedures. However, code 110043 is not eligible for assistant surgeon reimbursement, and you will be unable to use the AS modifier with this procedure code. Procedure code 11046 does allow for assistant surgeon reimbursement when supported, but this is not a standalone code and you can use this code as well as the modifier only with a primary code.

You can try to claim both codes with modifier AS and allow the insurance company to process the claim according to their policy. You should attach all relevant procedure notes and also the requesting physician’s need for an assistant surgeon. You should also attach the request letter from the primary physician asking for the assistance.