Podiatry Coding & Billing Alert

Question: I’m not sure how to correctly report 29540 and 20550. I’ve been told they are bundled together, but I’ve also heard that they’re only bundled if the doctor uses the same diagnosis code for both procedures. If I bill 20550 with M77.9 and 29540 with M72.2, can I attach modifier 59?

Montana Subscriber

Answer: According to the April 2017 Correct Coding Initiative (CCI) edits, the Column 1 code, 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [eg, plantar “fascia”]), is bundled with the Column 2 code — 29540 (Strapping; ankle and/or foot).

However, since the edit has a modifier indicator of 1, you can use a modifier to override this edit when appropriate.

Just report injection: If your podiatrist performs a related tendon sheath or ligament injection on the same day as the patient undergoes a strapping to her ankle or foot, just report the injection.

Appropriate to override the edit: However, if the medical documentation supports that your podiatrist performed the injection and the strapping at different anatomical sites, during different patient encounters, or for different diagnostic reasons, you can report both the strapping and the injection. In this case, it would be appropriate to append modifier 59 (Distinct procedural service) to 29540, effectively overriding the CCI edit.

Remember: When you override an edit, the documentation and clinical circumstances must always support your decision to use the modifier. You should never append a modifier just to bypass the edit.