Podiatry Coding & Billing Alert

Discover why E/M and strapping can't go together as separate codes

Did you know that the Correct Coding Initiative (CCI) bundles Unna boot application to many other comprehensive surgeries (e.g. tendon sheath injections, joint aspiration/injection, etc.)? If you're pulling your hair from confusion about this and many other questions about coding Unna boot application, the following Q&As should shed you some light on how to code it properly.

Question 1: What Is Unna Boot's Purpose?

Answer: The New York Medicare carrier National Government Services LCD L6979 defines Unna boot as a dressing used to treat varicose ulcers of the lower extremities, which are due to increased venous pressure, venous insufficiency, or capillary dysfunction. It consists of a bandage impregnated with a gelatin, zinc oxide, and glycerin paste that the provider layers on the leg ulcer until the bandage becomes rigid.

 "The resulting pressure and bacteriostatic properties assist in healing," the LCD states.

Question 2: Do You Get Paid for the Supplies With Unna Boot?

Answer: You shouldn't consider Unna boots applied as dressings a separately reimbursable service apart from surgical procedure.

According to CCI, payment for surgical dressings applied by the physician during his/her encounter with the patient is included in the fee schedule payment for the physician's service.

Medically necessary Unna boots, not applied as post-op dressings, use the CPT 29580 (Strapping; Unna boot). Just the same, you should never code for any supplies. Payers include the cost of all Unna boot bandages, straps and paste in their payment for 29580.

However, you should report change in dressings every few days, while the patient is in Unna boot, with 29580, which has a global period of zero days.

Question 3: Can I Bill an E/M With 29580

Answer: You may report an Unna boot application with 29580 in addition to the appropriate E/M code only under this situation: The boot application is provided as an initial service with no expectation that the physician who rendered only the original care will perform another treatment or procedure.

In other words, if the patient has a new or different complaint that necessitates a separate and significant E/M service, you may bill an appropriate E/M code. Don't forget to append appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

Reminder: You would need to attach a separate diagnosis to the E/M service to further differentiate it from the "inherent" E/M service included in the Unna boot application.

Question 4: What If Doc Performed a Debridement Too?

Answer: Debridement prior to applying the Unna boot is a typical procedure that podiatrist performs. You can report debridement (for example, 11040, Debridement; skin, partial thickness) during the same session as 29580 only if the services apply to separate anatomical areas (separate feet).

Quick fact: CCI has bundled column-2 code 29580 into column-1 codes 11040-11044 as a standard of medical/surgical practice, Jo Ann F. Kergides, CPC-H, physician services coder at UMDNJ-SOM Vascular Surgery in Stratford, N.J. The modifier indicator of 1 allows you report both procedures separately using modifier 59 (Distinct procedural service). For example, the physician performs a debridement on the patient's right foot and applies an Unna boot to the left foot.

Question 5: What ICD-9 Codes Should Go With 29580?

Answer: Depending on the payer, 29580 links to ailments such as varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will accept additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19). As always, you should report the diagnosis according to your physician's documentation.

Do: Make sure you check with your payer on current policy or update for the different diagnoses.