Wiki Unna boot reimbursement issues

[cathygigliotti]

I am having issues with Unna boot reimbursements. The Mohs surgeon is billing the Unna boot, CPT 29580 (with correct LT/RT/50 modifier) with a diagnosis of venous insufficiency (I87.2). They have paid but are now being recouped stating not payable per Medicare guidelines. I have been reading through the LCD for the 29580 and I am trying to understand if they are even payable. It looks like on the LCD, the boot is only payable if there is an ulceration due to the venous insufficiency. Am I reading this correctly?

As an example, the surgeon is removing a basal cell carcinoma from the left lower limb. To help with venous insufficiency the Unna boot is applied at the follow-up visits, once every seven days. Is this payable? Does it need a modifier as being part of the original Mohs surgery? I feel like I am seeing more and more denials for the Unna boot and no real reason why. Should 29580 be billed as part of the original Mohs surgery as well if they apply it there, or is included in the surgery itself?

Any help is greatly appreciated as I am seeing more issues with CPT 29580 being paid.

Thank you!

Cathy

 

[CatchTheWind]

Our MAC (First Coast Service Options) has a very limited list of ICD codes that Unna boot can be used for, but venous insufficiency is actually one of those. So I don't know why they are doing this.

 

[cathygigliotti]

When I look at the LCD for KY, there are not even ICD-10 codes listed that will cover, but a specific guideline:

Special instructions for code 29580 – Strapping; Unna boot
The application of Unna boot paste (zinc, gelatin, or other product) as a bandage or “colloid” dressing, is applied to an extremity for the treatment of dermatological, vascular, and on occasion, other conditions. These dressings are often covered by an elastic bandage to give added support, hold the dressing in place and provide a protective cover. Unna boot application is appropriate in the treatment of ulcerations with and without inflammation due to stasis dermatitis produced by vascular insufficiency. The Unna boot is also appropriate for treating ligamentous injuries (sprains and strains) of the ankle. Unna boots need to be changed on a regular basis, depending on the exact type used and the indication. Bilateral unna boots should be billed with a modifier -50 (bilateral procedure).

https://www.cms.gov/medicare-covera...tucky&CptHcpcsCode=29580&bc=gAAAACAAAAAAAA==&


Everything I have seen says that I87.2 should be covered so I can't figure out why they are now coming back as not payable.