General Surgery Coding Alert

Question: Our physicians are surgeons, and from time to time they perform minor surgical procedures while seeing patients in the office. For example, what is the best way to bill for an unna boot and office visit?

Cindy L. Weberg, Insurance Supervisor
Muskegon Surgical Associates P.C., Muskegon, Mich.

Answer: General surgeons typically use unna boots to treat swelling of the legs caused by ulcers and to control postoperative edema resulting from an amputation. The unna boot is a semirigid dressing comprised of a paste of zinc oxide, gelatin and glycerin that is applied to the skin of the leg, which then is gauze wrapped. The dressing is replaced at least once a week or more as needed. The supplies for the unna boot are included in the procedure (29580, strapping; unna boot) and may not be billed separately, says Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.

Because the unna boot is applied during a series of visits, when the patient returns only the procedure itself can be billed. No evaluation and management (E/M) visit is billable unless the patient has another significant problem, in which case modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be attached to the appropriate E/M service code.

If the patient has gout ulcers and also requires debridement, code 11000 (debridement of extensive eczematous or infected skin; up to 10% of body surface) should be billed in addition to the 29580.