Get Well-Versed with Accidental Foot GSW Story

Get expert wound care answers.

Inaccurately coding wound care claims can result in a breakdown in your bottom line. Go through these wound care questions and answers to decide if your wound medical coding knowledge means a quick reimbursement or necessitates immediate treatment. Read this article for accurate medical coding.

Question #1: In case your podiatrist examines a patient in the ED to treat a hunting gunshot wound in the foot that involves broken metatarsal bones that the podiatrist should repair in the operating room, should you report the tissue or bone injury and repair as the primary diagnosis as well as the procedure?

Answer: A gunshot wound to the foot is actually a high-velocity wound that is likely to have fractures and needs an aggressive washing along with cleaning of the wound owing to contamination from sock and shoe material and dirt.

Based on the condition above, you're also going to have to do multiple debridements.

The rules state you must list things in order with the procedure that makes use of the most time and skill for that needed service first. In this scenario, the debridement of the open compound fracture would take preference, as it's a bigger code in terms of RVUs.

Consequently, for accurate medical coding, you would code the wound as 1101x (Debridement including removal of foreign material at the site of an open fracture[s] and/or dislocation[s]...) associated with diagnosis code 892.1 (Open wound of foot except toe[s] alone; complicated), as well as 28485 (Open treatment of metatarsal fracture, includes internal fixation, when performed, each) related to 825.30 (Fracture of unspecified bone[s] of foot [except toes]; open).

Question #2: What codes should you report for compression therapy for patients who have venous stasis ulcers?

Answer: There's no individual code for compression therapy for venous stasis ulcers because there is for statin therapy. Podiatrists carry out treatment for venous stasis ulcers with a number of modalities according to the situation. For instance the Unna boot, for which you may only report the application of the boot (29580, Strapping; Unna boot), however not the boot itself.

Other modalities involve Ace wraps along with compression markers (HCPCS code A6449, Light compression bandage, elastic, knitted/woven, width greater than or equal to 3 in. and less than 5 in., per yard) as well as Profore, which is a multi-layer compression bandage system.

Medical Coding Tip: Report Profore along with 29580, and then think of appending modifier 22 (Increased procedural services) to explain for the multiple layers that the podiatrist should apply. You must then link the CPT® code to ICD-9 code 454.0 (Varicose veins of lower extremities; with ulcer).

Venous stasis wounds are caused when the veins in the lower leg don't work so well and you get leakage of venous blood and swelling of the legs. The ulcers are a consequence of the poor blood exchange and the swelling.

67311-67318 Success Rests on Thorough Anatomy Understanding

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When an ophthalmologist carries out strabismus surgery, it can include any combination of 12 extraocular muscles. Inaccurately identifying just one of those muscles can lead you to the incorrect code -- and miss more than $700 in reimbursement. Read this article to pin down precise CPT codes for error-free medical coding.

However you don't require being an expert in anatomy to get the eye muscles straight -- all you require are the answers to the following listed frequently asked questions to guide you toward selecting the right code to report your practice's strabismus treatments.

Question 1: How do you select the correct strabismus surgery code based on the ophthalmologist's operative notes?

Answer: A little knowledge of the eye's anatomy goes a long way toward understanding strabismus-correcting procedures. Which CPT codes you report rests on the definite extraocular muscle or muscles the ophthalmologist operated on.

Each eye has six extraocular muscles that ultimately control the eyeball's movement and regulate the eyeball's alignment, or in few cases misalignment. Strabismus surgery is the rectification of misalignment with the possible restoration of quality visual activity.

CPT® differentiates the strabismus surgery CPT codes (67311-67318) by whether the procedure includes horizontal, vertical, or superior oblique muscles.

Question 2: Is strabismus surgery taken as unilateral or bilateral?

Answer: The strabismus surgery CPT codes (67311-67318) are characteristically unilateral, defining procedures carried out in one eye only. When CPT codes mention more than one muscle, CPT® is denoting that those muscles are in the same eye. Consequently, in case the surgeon resects one horizontal muscle in each of the eye, 67312 would not be appropriate. In that case, report 67311 bilaterally.

Payer preferences differ on the usage of modifiers 50 (Bilateral procedure). A lot of Medicare carrier payers desire that you should list the code once with the bilateral modifier appended (e.g., 67311-50).

Medicare normally reimburses for 67311-50 based on 150 percent of the specific fee schedule amount for a solitary code. The 2011 fee schedule allocates 17.16 national unadjusted facility RVUs to 67311, which earns $583.04 when multiplied by the 33.9764 conversion factor.

Though, in case the ophthalmologist recesses the lateral rectus along with the definite medial rectus muscles of the left eye, you are not medical coding a bilateral procedure. This is a case in which 67312 would be incorrect. CMS would reimburse this at an amount of $705.35 (20.76 RVUs x 33.9764, unadjusted for geographic location).

Hidden trap: The same rules are applicable to the vertical muscle CPT codes, even though the wording "two or more vertical muscles" in the definition of 67316 may make you think it's a bilateral code, as there are precisely only two vertical muscles in one eye.