Podiatry Coding & Billing Alert

Question: Can we report a toenail trim which our podiatrist performed when a patient came in for a problem focused visit related to an ingrown toenail? The documentation notes: The patient’s chief complaint is an ingrown infected nail on the right foot, great toe; the doctor performs an avulsion. The patient also states that his left ankle is sore and may be twisted. The physician evaluates and documents his “bullets” for an appropriate E/M satisfactorily. The physician discusses the ankle with the patient and documents the time and history taken. In this case, time was 10 minutes and two out of three components required for 99212 (a problem-focused history and a problem-focused examination) are documented. The physician also orders a two-view x-ray of the ankle and evaluates the ankle to determine a minor sprain/strain.

New York Subscriber

Answer: Podiatrists can get paid for 11720 (Trimming of nail[s] by any method[s], 1 to 5) and 11721 (… 6 or more) and 99212 (Office or other outpatient visit…) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same say of the procedure or other service) says Arnold Beresh, DPM, CPC, CSFAC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.

Dx codes are key: Make sure you have separate and identifiable diagnosis codes. Modifier 25 is a target for audits, so be sure to totally document the ICD-10 codes and the time spent.

The correct coding for this situation would be:

• 99212 with modifier 25 and a diagnosis of S93.409A (Sprain of unspecified ligament of unspecified ankle, initial encounter) or S96.919A (Strain of unspecified muscle and tendon at ankle and foot level, unspecified foot, initial encounter).
• 11730-T5 (Avulsion of nail plate, partial or complete, simple; single; Right foot, great toe) with L60.0 (Ingrowing nail).
• 73600-RT (Radiologic examination, ankle; 2 views; Right side) with S93.409A or S96.919A. Depending on the complexity of the problem, your choices could range to S93.401A (Sprain of unspecified ligament of right ankle, initial encounter) or S93.402A (Sprain of unspecified ligament of left ankle, initial encounter).

Keep in mind that some insurance companies will automatically deny an E/M with a procedure and these must be appealed with documentation that the 99212 was not for the ingrown nail complaint. Modifier 25 is justifiable because one service has nothing to do with the other and multiple services were performed.

To justify the diagnosis of S93.409A or S96.919A the documentation must include the date and time of the sprain or the claim will be flagged. The physician simply needs to make a note in the patient’s chart that ‘to the patient’s most accurate recollection, the injury took place on X date at X time.’