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

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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

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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

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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

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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)

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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

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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

Jfrederick@aappm.org

Coding and Billing seminar

November 30, 2012 Arizona

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