Any one have any good resources in regards how to under and code debridement of ulcers , routine foot care and trimming of nails. I feel there is so much info and looking for sources to help understand how to code, what to look for etc etc, feel a little loss :/ I would greatly appreciate any feedback or recommendations of books, videos or webinars .. Thank you
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Wiki Podiatry
- Thread starter KoBee
- Start date
Mayzoo
Expert
US Podiatry Billing Cheat Sheet – what are the billing codes?
In-Clinic Services
99203 – 99204 Office Visit New Patient Level 3 – Level 4
99213 – 99214 Office Visit Established Level 3 – Level 4
29405 Apply Short Leg Cast (Non-weight Bearing)
Q4038 Short Leg Cast Material
20550 Injection Tendon Sheath/Ligament
J3301 Triamcinolone Acetonide (Typically 1 unit used)
Nail Care and Nail Procedures
11720 Toenail Trim (1 Foot)
11721 Toenail Trim (2 Feet)
11730 Toenail Removal
11750 Toenail Removal (Permanent)
97597 Debridement of Open Wound
17110 Wart or Lesion Removal Up to 14 (Benign)
Orthotics
L3020 Custom Orthotic Materials (OR002)
29799 Casting Impression Fitting (S0395)
97760 Orthotic Management and Training 15 Minutes EachDurable Medical Equipment
L4360 Ottobock Pneumatic Walker (Immobilizing Boot (SS406)
L4396 Foot Night Splint – Treatment for Plantar Fasciitis (SS397)
L1902 Ankle Brace (SS243)
Debridement cheat sheet--these can be tricky, so do some research on these:
What The Specific Debridement Codes Include
The CPT codes 11042-11047 for surgical debridement of the ulcer not only refer to ulcer size but also to levels of the actual tissue debrided. This is based on tissue type (e.g. partial skin, full thickness skin, subcutaneous tissue, bone, muscle, etc.) of non-contiguous skin and other deeper tissue structures.
First, let us review the debridement codes before we talk about what codes to bill.
Code 11042: debridement, subcutaneous tissue. This includes the debridement of epidermis and dermis, if performed, for the first 20 cm2 or less.
Code 11043: debridement, muscle and/or fascia. This includes debridement of epidermis, dermis and subcutaneous tissue, if performed, for the first 20 cm2 or less.
Code 11044: debridement, bone. This covers the debridement of epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, for the first 20 cm2 or less.
Code 11045: debridement, subcutaneous tissue. This includes the debridement of epidermis and dermis, if performed, for each additional 20 cm2 (list separately in addition to the code for the primary procedure).
Code 11046: debridement, muscle and/or fascia. This pertains to debridement of the epidermis, dermis and subcutaneous tissue, if performed, for each additional 20 cm2. List this separately in addition to the code for the primary procedure.
Code 11047: debridement, bone. This includes debridement of epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, for each additional 20 cm2. List separately in addition to the code for the primary procedure.
Code 11055: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for a single lesion.
Code 11056: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for two to four lesions.
Code 11057: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for more than four lesions.
Code 97597: debridement. This pertains to the use of high pressure water jet with/without suction or sharp selective debridement (with scissors, scalpel and forceps) for an open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session of total wound(s) surface area for the first 20 cm2 or less.
Code 97598: debridement. This covers high pressure water jet with/without suction or sharp selective debridement (with scissors, scalpel and forceps) for an open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session of total wound(s) surface area. It pertains to each additional 20 cm2 or part thereof. List separately in addition to the code for the primary procedure.
.
Most commonly audited Codes: https://www.picagroup.com/site/binaries/content/assets/documents/10.7.15_warshawwebinar.pdf
And a general google search results: Click HERE
In-Clinic Services
99203 – 99204 Office Visit New Patient Level 3 – Level 4
99213 – 99214 Office Visit Established Level 3 – Level 4
29405 Apply Short Leg Cast (Non-weight Bearing)
Q4038 Short Leg Cast Material
20550 Injection Tendon Sheath/Ligament
J3301 Triamcinolone Acetonide (Typically 1 unit used)
Nail Care and Nail Procedures
11720 Toenail Trim (1 Foot)
11721 Toenail Trim (2 Feet)
11730 Toenail Removal
11750 Toenail Removal (Permanent)
97597 Debridement of Open Wound
17110 Wart or Lesion Removal Up to 14 (Benign)
Orthotics
L3020 Custom Orthotic Materials (OR002)
29799 Casting Impression Fitting (S0395)
97760 Orthotic Management and Training 15 Minutes EachDurable Medical Equipment
L4360 Ottobock Pneumatic Walker (Immobilizing Boot (SS406)
L4396 Foot Night Splint – Treatment for Plantar Fasciitis (SS397)
L1902 Ankle Brace (SS243)
Debridement cheat sheet--these can be tricky, so do some research on these:
What The Specific Debridement Codes Include
The CPT codes 11042-11047 for surgical debridement of the ulcer not only refer to ulcer size but also to levels of the actual tissue debrided. This is based on tissue type (e.g. partial skin, full thickness skin, subcutaneous tissue, bone, muscle, etc.) of non-contiguous skin and other deeper tissue structures.
First, let us review the debridement codes before we talk about what codes to bill.
Code 11042: debridement, subcutaneous tissue. This includes the debridement of epidermis and dermis, if performed, for the first 20 cm2 or less.
Code 11043: debridement, muscle and/or fascia. This includes debridement of epidermis, dermis and subcutaneous tissue, if performed, for the first 20 cm2 or less.
Code 11044: debridement, bone. This covers the debridement of epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, for the first 20 cm2 or less.
Code 11045: debridement, subcutaneous tissue. This includes the debridement of epidermis and dermis, if performed, for each additional 20 cm2 (list separately in addition to the code for the primary procedure).
Code 11046: debridement, muscle and/or fascia. This pertains to debridement of the epidermis, dermis and subcutaneous tissue, if performed, for each additional 20 cm2. List this separately in addition to the code for the primary procedure.Code 11047: debridement, bone. This includes debridement of epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed, for each additional 20 cm2. List separately in addition to the code for the primary procedure.
Code 11055: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for a single lesion.
Code 11056: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for two to four lesions.
Code 11057: paring or cutting of benign hyperkeratotic lesion. This pertains to corn or callus for more than four lesions.
Code 97597: debridement. This pertains to the use of high pressure water jet with/without suction or sharp selective debridement (with scissors, scalpel and forceps) for an open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session of total wound(s) surface area for the first 20 cm2 or less.
Code 97598: debridement. This covers high pressure water jet with/without suction or sharp selective debridement (with scissors, scalpel and forceps) for an open wound, (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session of total wound(s) surface area. It pertains to each additional 20 cm2 or part thereof. List separately in addition to the code for the primary procedure.
.
Most commonly audited Codes: https://www.picagroup.com/site/binaries/content/assets/documents/10.7.15_warshawwebinar.pdf
And a general google search results: Click HERE
01503628
Networker
Hi All,
As I'm new to billing, please some one guide me with the maximum units to get paid for CPT 11046. I received the document support for 11046*40 units.
Any suggestions would be helpful.
As I'm new to billing, please some one guide me with the maximum units to get paid for CPT 11046. I received the document support for 11046*40 units.
Any suggestions would be helpful.
sam.anderson@curemd.com
Contributor
- Messages
- 10
- Best answers
- 0
Hi,
Why Insurance is not processing 11042 or 99213 together and we are getting denial in bulk when billed in follow-up visit of surgery. Can anyone provide some information on this.
Why Insurance is not processing 11042 or 99213 together and we are getting denial in bulk when billed in follow-up visit of surgery. Can anyone provide some information on this.
podcoder70
Expert
Please provide more information, how is it being billed, what diagnosis codes, what supports the e&m with the procedure?
amyjph
True Blue
This is too vague of a question. There could be many reasons for this. Are they in a global period and the services performed are related? Does the documentation support a 25 modifier and separate E/M. Was the debridement coded correctly according to the documentation and description of 11042? What were the diagnosis codes?