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7/21/2012
1
Jeffrey Frederick, DPM, FASPS
President, American Academy of Podiatric
Practice Management
John Guiliana, DPM, FASPS
Trustee, AAPPM
Louis J. Geller, DPM, CWS, FACFAS, FASPS,
FAPWCA
CODING 101:
HOW TO GET PAID FOR
EVERYTHING YOU DO
The opinions given are not necessarily the opinion of the
AAPPM and are subject to interpretation by each individual. It
is not a substitute for professional legal, financial or medical
advice---coding rules and payment policies can differ from
carrier to carrier.
HEALTH CARE 2012
If you can't afford a doctor, go to the airport -
you will get a free x-ray and a breast exam.
If you mention Al Qaeda,
you will also get a free colonoscopy.
PRACTICE MANAGEMENT TIP
Things you are
missing in your off ice:
1/ 17/ 12 2:17 PMProcedure Codes Payable for Podiatr ists
Page 1 of 2http:/ / www.wpsmedicare.com/ part_b/ resources/ provider_types/ podiatr ist- codes.shtml
Illinois, Michigan, Minnesota and Wisconsin Providers
Home Part B Resources Provider Types Procedure Codes Payable For Podiatrists
Procedure Codes Payable For Podiatrists
Effective 01/01/2011
Below is a list of the procedure codes that have been approved as payable for
podiatrists by the medical director staff.
10060, 10061, 10120, 10121, 10140, 10160, 10180, 11000, 11001, 11010-11012,
11040-11047, 11055-11057, 11100, 11101, 11200, 11201, 11300-11302, 11305-
11308, 11400-11404, 11406, 11420-11424, 11426, 11606, 11620-11624, 11626,
11719-11721, 11730, 11732, 11740, 11750, 11752, 11755, 11760, 11762, 11765,
11900, 11901, 12001, 12002, 12004-12007, 12020, 12021, 12041, 12042, 12044-
12047, 13120, 13121, 13131-13133, 13160, 14040, 14041, 14300, 14302, 14350,
15004, 15005, 15050, 15320, 15321, 15335, 15336, 15340, 15341-15343, 15350,
15351, 15360, 15365, 15366, 15400, 15401, 15420, 15421, 15430, 15574, 15620,
15738, 15851, 15852, 15999, 16000, 16010, 16020, 16035, 16036, 17000, 17003,
17004, 17106-17108, 17110, 17111, 17250, 17270-17274, 17276, 17999, 20000,
20005, 20103, 20200, 20205, 20206, 20220, 20240, 20245, 20500, 20501, 20520,
20525, 20550-20553, 20600, 20605, 20612, 20615, 20650, 20670, 20680, 20690,
20692-20694, 20900, 20902, 20924, 20926, 20950, 20972-20975, 20979, 20999,
27603-27607, 27610, 27612-27615, 27618-27620, 27625, 27626, 27630, 27632,
27634, 27635, 27637, 27638, 27640, 27641, 27645-27648, 27650, 27652, 27654,
27658, 27659, 27664, 27665, 27675, 27676, 27680, 27681, 27685-27687, 27690-
27692, 27695, 27696, 27698, 27700, 27702-27704, 27760, 27762, 27766-27769,
27786, 27788, 27792, 27808, 27810, 27814, 27816, 27818, 27822-27829, 27840,
27842, 27846, 27848, 27860, 27870, 27871, 27888, 27899, 28001-28003, 28005,
28008, 28010, 28011, 28020, 28022, 28024, 28030, 28035, 28039, 28041, 28041,
28043, 28045, 28046, 28047, 28050, 28052, 28054, 28055, 28060, 28062, 28070,
28072, 28080, 28086, 28088, 28090, 28092, 28100, 28102-28104, 28106-28108,
28110-28114, 28116, 28118-28120, 28122, 28124, 28126, 28130, 28140, 28150,
28153, 28160, 28171, 28173, 28175, 28190, 28192, 28193, 28200, 28202, 28208,
28210, 28220, 28222, 28225, 28226, 28230, 28232, 28234, 28238, 28240, 28250,
28260-28262, 28264, 28270, 28272, 28280, 28285, 28286, 28288-28290, 28292-
28294, 28296-28300, 28302, 28304-28310, 28312, 28313, 28315, 28320, 28322,
28340, 28341, 28344, 28345, 28360, 28400, 28405, 28406, 28415, 28420, 28430,
28435, 28436, 28445, 28450, 28455, 28456, 28465, 28470, 28475, 28476, 28485,
28490, 28495, 28496, 28505, 28510, 28515, 28525, 28530, 28531, 28540, 28545,
28546, 28555, 28570, 28575, 28576, 28585, 28600, 28605, 28606, 28615, 28630,
28635, 28636, 28645, 28660, 28665, 28666, 28675, 28705, 28715, 28725, 28730,
28735, 28737, 28740, 28750, 28755, 28760, 28800, 28805, 28810, 28820, 28825,
28890, 28899, 29345, 29355, 29405, 29425, 29435, 29440, 29445, 29450, 29505,
29515, 29540, 29550, 29580, 29581, 29590, 29700, 29705, 29730, 29740, 29750,
4
CODING POP QUIZ
When billing the following sequence of cpt codes which is the proper way to bill:
1) 11730 TA, 59 11721, 59
2) 11730 59, 11721, 59
3) 11730 TA 11721, 59
4) 11730 TA,RT 11721
5) 11730 RT 11721 59
6) trick question all are wrong, should not bill these together
7) I don’t worry about modifiers that’s my billers job
5
CCI EDITS – CORRECT CODING INITIATIVE
Created to stop un-bundling of CPT codes
If you perform a procedure additional procedures may be considered part of the f irst procedures payment; bunionectomy and associated capsulotomy
What procedures are bundled together?
How can you over-ride the CCI edit?
What should not be bundled – routine foot care/mycotic nails
6
7/21/2012
2
BEGIN WITH THE CORRECT TOOLS
www.apmacodingrc.org Recommended by the AAPPM
www. (your medicare carriers website)
7
APMACODINGRC.ORG
8
ADVANCE CODE SEARCH
9
CCI EDIT TABLE
10
DX ASSOCIATED WITH CPT CODE
11
MEDICARE GUIDELINES BY STATE
12
7/21/2012
3
DME GUIDELINES BY STATE
13
WHAT ABOUT ICD 10?
APMAcodingRC.org has you covered
Cross Walks and more
14
DIAGNOSIS YOU SHOULD
CONSIDER
Systemic disease is part of your
grading scale
Are you worth the money?
110.1 , 25000, 4439 more than just the numbers……
15
DX CODES: T inea Ped is 1 1 0.40
Ha l lux Va lgus 7 3 5 .0 0
Hal lux Rig idus 7 3 5 .2 0
Ta i lor 's Bunio n 7 27.10
Hemato ma and Co ntus ion 71 9 .17 & 9 24 .2 0
Hammer to e Defo rmity 7 3 5 .40
Hyper t rphic Bo ne Spur 7 3 3 .9
Metatarsal Jo int Defo rmity735.5 0
Ver ruca Vu lgaris/ Plantaris 07 8 ,10
Athero sclerosis O b l i terans 4 4 2 /2 0
Per iphera l Vascu lar D i sease, NO S 4 4 3 .9
O steo ar thros is , mul t iple j o in ts 71 5 .97
Spra in o f Ank le/Foot 8 4 5 .01
Rupture o f Tendo n o f Fo o t 7 2 6 .7 3
P lantar Fascia l F ib romato sis 7 2 8 .71
Ach i l les Tendo nit is 7 2 6 .71
Abcess o f To e 6 81 .10
Abcess o f Ank le o r Fo o t 6 8 2 .70
U lcerat ion o f Leg , NO S 7 07.10
Decub i tus U l cer o f Fo o t 7 07.07
Per iost i t is w/o O steomyel i t is 7 3 0 .07 O steo myelt is , Acute 7 3 0 .27
Ingro wing Nai l 7 0 3 .0
O nycho mycosis 1 1 0 .1
Pa in in L imb7 29.5
D iabetes Mel l i tus (need 5 -d ig i ts fo r speci f ic i ty) 2 5 0 .xx
Defo rmity o f Ank le and Fo o t , Acqu i red 7 3 6 .79
Unspecif ied Fo reign Bo dy (g lass , etc . ) 917.6
Fracture, Pha lanx, c lo sed 8 2 6 .0
Fracture, Metatarsa l , c lo sed 8 2 5 .2 5
Fracture, Ank le , c lo sed 8 24 .8
Gangl ion Cyst 7 27.4 3
Mo r ton 's Neuroma 3 5 5 .6
Mo no neurit is o f Unspecf ied S i te 3 5 5 .79 Ank le Spra in 8 4 5 .0 0
Latera l Ank le Spra in 8 4 5 .0 2
Media l Ank le Spra in 8 4 5 .01
Tarsa l Tunnel Syndrome 3 5 5 .5
Abnormality of Gait 781.2
Muscle Weakness 728.87
Numbness 782.0
Tenosynovitis 727.09
Osteoar thr it is Ankle 715.17
16
PART B NATIONAL SUMMARY DATA
Formerly known as BESS (Part B Extract Summary System)
Data BMAD DATA
How Medicare tracks the most commonly bil led CPT Codes
Available for all medical specialties
The most up-to-date data that we currently have is 2011
Top 25 Billable Codes for Podiatry
1. 11721 10. 99348 19. 20605
2. 99213 11. 20600 20. 99347
3. 99212 12. 11042 21. 11055
4. 11730 13. J1100 22. 73620
5. 11720 14. Q4106 23. 99307
6. 73630 15. 99202 24. 11719
7. 97597 16. 10060 25. 29580
8. 11056 17. 17110
9. 99203 18. 11732
PART B NATIONAL SUMMARY DATA-
TOP 25 BILLABLE PODIATRY CODES
7/21/2012
4
73620: 2 views foot
$21.08
73630: 3 views foot
$24.36
73650: 2 views calcaneus
$21.84
FOOT X-RAYS:
73620 (#22), 73630 (#6), 73650 NAIL PROCEDURE CODES
Some Of The Most Audited Codes In Podiatry
11730- Avulsion of nail plate, partial or complete, simple; single
11732- Avulsion of nail plate, partial or complete, simple; each additional nail plate (L ist separately in addition to code for
primary procedure)
Involves separation and removal of the entire nail plate or a portion of nail plate (including the entire length of the nail border to and under the eponychium)
A nail avulsion usually requires injected local anesthesia except in instances wherein the digit is devoid of sensation or there are other
extenuating circumstances for which injectable anesthesia is not required or is medically contraindicated
Regrowth of the nail and recurrence of ingrowth will require four months
11730 (#4), 11732 (#18), 11750, 11765
11750- Excision of the nail and the nail matrix performed
under local anesthesia requiring separation and removal of
the entire nail plate or a portion of nail plate (including the
entire length of the nail border to and under the eponychium)
followed by destruction or permanent removal of the
associated nail matrix
11765- Wedge excision of the nail fold hypertrophic
granulation tissue with removal of the offending portion of
the nail
11730 (#4), 11732 (#18), 11750, 11765
The patient’s primary symptoms and previous treatment (if
any) and description of the nail(s) at the time of avulsion
services
A complete detailed description of the procedure performed
including exact portion of nail removed
Post-operative instructions and any follow -up care
such as use of soaks, proper shoes and nail care, to prevent
recurrences, antibiotics and follow-up appointments
11730 (#4), 11732 (#18), 11750, 11765
DOCUMENTATION REQUIREMENTS
10060- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
10061- Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple
10060 (#16) AND 10061
10061 -T5 681.11
7/21/2012
5
26010- Incision and drainage of finger abscess; simple or single ($198.05
26011- Incision and drainage of finger abscess; complicated or multiple ($297.04
Don’t forget to use your finger modifiers (FA-F9)
26010 AND 26011
26011 -F2 681.11
29580- Application
of an UNNA Boot
($39.97)
29581- Application
of a multi-layer
compression
system; leg (below
knee), including
ankle and foot
($45.62)
29580 (#25) VS. 29581
17250: Chemical
cauterization of
granulation tissue
(proud flesh, sinus
or fistula)
Silver Nitrate
WOUND CAUTERY
CMS requires doctors to retain their medical records for how
long a period of t ime?
Forever, since they don’t care about the cost of storage
5 years from the date of service
6 years from the date of service
7 years from the date of service
10 years from the date of service if the patient is a Medicare
managed care program
POP QUIZ
INJECTION CODES
20600- Arthrocentesis,
aspiration and/or
injection; small joint or
bursa (e.g., fingers, toes))
20605- Arthrocentesis,
aspiration and/or
injection; intermediate
joint or bursa (e.g., ankle) ***Not u sed f o r p lantar f ascii tis***
20600 (#11) VS. 20605 (#19)
7/21/2012
6
20550- Injection(s);
s ingle tendon sheath, or
l igament, aponeurosis
(e.g., plantar "fascia”)
20551- Injection(s);
s ingle tendon
origin/insertion
20550 VS. 20551
64455: Injection(s),
anesthetic agent
and/or steroid,
plantar common
digital nerve(s) (eg,
Morton's neuroma)
64450: injection,
anesthetic agent;
other peripheral
nerve or branch –
not for neuroma
NEUROMA INJECTION
10021: Fine Needle
aspiration without
imaging ($112)
10022: Fine Needle
aspiration when
performed with
imaging guidance
NEEDLE ASPIRATION – FLUID, GANGLION
J1020- Methylprednisolone acetate 20mg- $3.12
J1030- Methylprednisolone acetate 40 mg- $3.10
J1094- Dexamethasone acetate 1mg- $0.23
J1100- Dexamethasone sodium phosphate 1mg- $0.11
J3301- Triamcinolone acetonide 10mg- $1 .69
J3303- Triamcinolone hexacetonide per 5mg- $1 .68
J9040- Bleomycin
Billed out at 15 units- $25.58 per unit ($383.70)
J-CODES
Example#1: J1100-Dexamethasone, 1 mg
Your bottle says 4 mg/ml
If you use 0.25 cc (1 mg) = 1 Unit
If you use 0.5 cc (2 mg) = 2 Units
If you use 0.75 cc (3 mg) = 3 Units
If you use 1.0 cc (4 mg) = 4 Units
HOW TO APPROPRIATELY BILL J CODES
BY UNITS
Example#2: J1030 Methylprednisolone
Acetate, 40 mg (Depo-Medrol)
Your bottle says 40 mg/ml
If you use 0.25 cc 10 mg = 1 Unit
If you use 0.5 cc 20 mg = 1 Unit
If you use 0.75 cc 30 mg = 1 Unit
If you use 1.0 cc 40 mg = 1 Unit
If you use 2.0 cc 80 mg = 2 Units
HOW TO APPROPRIATELY BILL J CODES
BY UNITS
7/21/2012
7
Example#3: J3301 Triamcinolone Acetonide,
(Kenalog-10, Kenalog-40) per 10 mg
Your bottle says Kenalog 40 =40mg/ml
If you use 0.25 cc 10 mg/40 mg = 1 Unit
If you use 0.5 cc 20 mg/40 mg = 2 Units
If you use 0.75 cc 30 mg/40 mg = 3 Units
If you use 1.0 cc 40 mg/40 mg = 4 Units
HOW TO APPROPRIATELY BILL J CODES
BY UNITS
Example#4: J0702 Betamethasone Acetate
and Betamethasone Phosphate, per 3 mg
(Celestone Soluspan 6 mg/ml)
If you use 0.25 cc 1.5 mg/6 mg = 1 Unit
If you use 0.5 cc 3 mg/6 mg = 1 Unit
If you use 0.75 cc 4.5 mg/6 mg = 1 Unit
If you use 1.0 cc 6 mg/6 mg = 2 Units
HOW TO APPROPRIATELY BILL J CODES
BY UNITS
10140- Incision and drainage of hematoma, seroma or fluid collection
10160- Puncture aspiration of abscess, hematoma, bulla, or cyst
10140 AND 10160
11100: Cutaneous
Biopsies – punch
Single lesion
11101: Cutaneous
each additional
biopsy add on code
BIOPSY
28118: Ostectomy,
calcaneus (includes
retrocalcanel bursa
removal and
exposure of achilles
28200: repair,
tendon flexor foot
without free graft (if
other work is done
on achilles other
than exposure –
debridement of
necrotic tissue
Add this code
HAGLUNDS DEFORMITY
When performing a
Subtalar
Arthroereisis (Screw
thingy) which would
be the correct way to
code for this
procedure:
28725 Subtalar
arthrodesis
28585 open
treatment of
talotarsal joint
dislocation
28899 unlisted
S2117 Temporary
code
POP QUIZ
7/21/2012
8
https://cissecure.nci.nih.gov
/ncipubs/detail.aspx?prodid
=P133
Diagnosis codes
V15.82: History of tobacco use
305.1: Tobacco use disorder
SMOKING CESSATION- 99406
99406: Smoking and tobacco use cessation counseling visit ;
intermediate, greater than 3 minutes up to 10 minutes
“ I advised the pat ient to stop smoking as tobacco/nicotine use
can cause de lays in sk in heal ing, wound healing, surgical
healing, tendon and l igament healing, bone heal ing, can cause
sk in graf t/skin graft substitute fai lure and can cause
problems with his/her circulation. The pat ient re lates that
he/she understands al l that was discussed .”
$10.28/$8.77
Can bill this 2 times/year
SMOKING CESSATION- 99406
G0180- Cer tification: Physician services for initial
certification of home health services, bil lable, once for a
patient’s home health certification period
This code will be util ized when the patient has not received
Medicare-covered home health services for at least 60 days
G0179- Re-Certification: Physician services for re -certification
of home health services, bil lable once for a patient’s home
health certification period
This code will be util ized after a patient has received home
health services for at least 60 days (or one certification
period) when the physician signs the certification after the
initial certification period
CARE PLAN OVERSIGHT (CPO):
HOW MUCH MONEY ARE YOU LEAVING ON THE
TABLE?
E&M ADD-ON CODES- BILLED IN ADDITION TO
YOUR E&M CODES
99050: Services provided in the office at t ime other than
regularly scheduled office hours or when the office is usually
closed beyond 9 to 5 (in addition to the basic service ) -
~$25.00
99051: Services provided in the office during regularly
scheduled evening, weekend, or holiday hours (in addition to
the basic service)- ~$25.00
ORTHOTICS CODES TO CONSIDER
L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each
L3000 RT……….$x
L3000 LT………..$x
L3020 Foot insert, removable, molded to patient model, longitudinal/metatarsal support, each
29799: Casting -LT $75 - $100
29799: Casting -RT $75 - $100
S0395: (Aetna/Cigna): Impression casting of a foot
performed by a practit ioner other than manufacturer of the
orthotic
99002: Handling, mailing, packaging $10 A4580: Material plaster $40
As of June 11, 2012, a Coding
Clarification was made by
Jurisdiction B DME in regards to
Toe Fillers and Diabetic Shoe
Inserts
7/21/2012
9
TOE FILLERS AND DIABETIC SHOE INSERTS
– CODING CLARIFICATION
Questions have arisen about the correct coding for shoe
inserts used to accommodate missing digits (toes) on feet for
beneficiaries with and without diabetes.
These items fall under two separate benefit categories and
use two distinct Healthcare Common Procedure Coding
System (HCPCS) codes, L5000 and A5513.
BENEFICIARIES WITHOUT DIABETES
Shoe inserts for beneficiaries with missing toes or partial foot
amputations who are not diabetic are considered for coverage
under the prosthetic benefit. Code L5000 is described by:
L5000 - Partial foot, shoe insert with longitudinal arch, toe
fi l ler
L5000
Code L5000 describes a shoe insert with a rigid longitudinal
arch support that also incorporates material accommodating
the void left by the missing digit(s) or forefoot.
Additional soft material is added where contact is made with
the residual l imb/toes. For beneficiaries missing digits,
particularly the hallux (great toe), or the forefoot, L5000
inserts are designed to provide standing balance and toe off
support for improved gait. The biomechanical control required
of L5000 differs from the foot -protective function provided by
inserts used as part of diabetes management.
L5000
For beneficiaries who require accommodation of missing foot
digit(s) or forefoot, suppliers must only b i l l code L5000.
Codes A5512 and A5513 describe inserts used with
therapeutic shoes provided to persons with diabetes and must
not be billed for non-diabetic beneficiaries.
BENEFICIARIES WITH DIABETES
A separate benefit category allows Medicare coverage of therapeutic shoes and inserts for persons with diabetes. Shoe inserts for persons with diabetes are described by the codes below:
A5512 - For diabetics only, multiple density insert , direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
A5513 - For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher), includes arch fi l ler and other shaping material, custom fabricated, each
BENEFICIARIES WITH DIABETES
For a beneficiary with diabetes missing digit(s) or a forefoot, suppl iers have two options for bi l l ing inser ts:
Option 1 : For diabetic beneficiaries who do not require the r igidity and suppor t af forded by code L5000 (e.g., beneficiaries missing digits excluding the hal lux), suppl iers must bi l l code A5513 for an inser t appropriately custom-fabricated to accommodate the missing digit(s) . Codes L5000 or A5512 may not be bi l led in addition to code A5513.
Option 2 : For beneficiaries missing the hal lux or a forefoot that require r igidity and suppor t for ef fective gait, suppl iers must bi l l L5000 for an inser t appropriately custom-fabricated to accommodate the missing digit(s) or forefoot as well as providing the foot -protective functions required for a person with diabetes. Codes A5512 or A5513 may not be bi l led in addition to code L5000.
7/21/2012
10
John has 32 candy bars, He eats
28, what does he have now?
MATH PROBLEM
Diabetes
Not Including Subq
97597 debridement not including subq <20 sq ( f i rest 20 sq)
97598 debridement not including subq >20 sq (each additional)
You can bi l l these together 97597 & 97598
Including Subq
11042 debridement includes subq < 20sq
11045 added i f > 20 sq
11043 includes subq/muscle/fascia <20 sq
11046 added i f > 20 sq
11044 includes subq/muscle/bone <20 sq
11047 added i f > 20 sq
DEBRIDEMENT CODES
A Medicare patient fails to show for their scheduled
appointment, knowing that there is a cost associated with the
time left blank by the patient not showing, which is true:
Bill ing Medicare for the no show would be inappropriate
Medicare does not allow bill ing the patient for the no show
Medicare requires bil l ing for the no show and after a rejection
will allow the patient to be billed
Medicare doesn ’t run our office or pay the overhead, so we bill
what we deem correct
Medicare allows bill ing the patient for the no show
POP QUIZ JUST AS IMPORTANT AS
THE CODES… MODIFIERS AND OTHER BILLING
INDICATORS
WHAT ARE MODIFIERS FOR?
They provide more information on your claim and increase
your chance for reimbursement
PLACE OF SERVICE CODES
11 – Office
12 – Home (Be sure to use for CMS DME !! )
21 - Inpatient Hospital
22 – Outpatient Hospital
23 – Emergency Room Hospital
24 – ASC
31- Skilled Nursing Facility
32 – Nursing Facility
7/21/2012
11
Using the wrong place-of-service code triggers
overpayments because Medicare Part B pays more
for certain physician services when they are provided
at offices or freestanding clinics rather than at
hospital departments, including provider -based
entities. The reason: professional fees include
overhead when services are provided at practices
and freestanding clinics. But Medicare Part B
reduces professional fees when physicians treat
patients in outpatient departments,
WHY POS MATTERS TOE MODIFIERS, IF YOU DO IT TO A TOE
YOU NEED A TOE MODIFIER!
Toes, Toes, Toes
TA = 1 st left T5 = 1 st right
T1 = 2nd left T6 = 2nd right
T2 = 3 rd left T7 = 3 rd right
T3 = 4 th left T8 = 4 th right
T4 = 5 th left T9 = 5 th right
LT = Left RT = Right
\
EVALUATION AND MANAGEMENT MODIFIERS
These Modifiers are only used on E/M codes: 99xxx
24
24 Unrelated E/M Service During a post operative visit
During a post operative visit (within the global period), the
patient presents with an acute onset of heel pain
99213 -24
25
25 Significant, separately identifiable Evaluation
and Management service by the same physician
on the same day as the procedure or other
service
During a visit for heel pain which requires an injection, the patient
also presents with an ingrown nail
99213 -25 (703.0)(728.71)
20550 (728.71) RT
SURGICAL MODIFIERS
7/21/2012
12
59
59 A procedure or service that was distinct or
independent from other services performed on
the same day
During a first metatarsal head osteotomy, the surgeon also
corrects a hammer toe deformity
28296 (735.0) RT
28285 (735.4) –RT, 59
79
79 Unrelated surgery during postop period
At the first post operative visit following a bunion surgery, the
patient presents with an ingrown nail requiring an I/D
99213 (703.0)(681.10) - 24
10060 (681.10) – 79 TA
ADVANCED BENEFICIARY NOTICES GA
GA Waiver of l iability statement on fi le – Use to indicate that the
physician’s office has a signed advance notice retained in the
patient’s medical record. The notice is for services that may be
denied by Medicare.
A patient presents for at risk foot care sooner than what is
normally allowed
GY
GY Waiver of l iability statement NOT on file – Use to indicate
when an item or service is statutorily excluded or does not meet
the definition of any Medicare benefit.
A patient presents for foot care without qualifying findings
GET PAID FOR YOUR HOSPICE PATIENTS!
7/21/2012
13
HOSPICE
GW or GV
GV- Attending physician not employed or paid under agreement
by the patient’s hospice provider.
GW - Service not related to the hospice patient’s terminal
condition.
DME RELATED MODIFIERS
KX
The KX modifier is added to claims for equipment that require
a certificate of medical necessity (CMN) or that currently
require a written order prior to delivery (WOPD).
A FREQUENTLY “MISSED” OPPORTUNITY
MODIFIER 76
76 Repeat procedure by same physician – The physician may
need to indicate that a procedure or service was repeated
subsequent to the original procedure or service
Repeat xray for manipulation of dislocation
Return to OR same day, implant dislocation
Even if you’re on the right track,
you’ll get run over if you just sit there.
Will Rogers
ICD 10 in 2014
NOTHING STAYS THE SAME
Coding and Billing seminar
November 30, 2012 Arizona
Up Next
How to bill correctly AT RISK FOOT
CARE
ROUTINE FOOT CARE –
AT RISK FOOT CARE