Orthopedic Coding Alert

You might be able to report same-day debridements separately from Unna boot application

You may think that 29580 for Unna boot applications is simple enough, but it's not the whole story. You might also be able to claim associated procedures, or be surprised to find that some services you thought were separate are included in the application itself. Begin With the Diagnosis As with any claim, you should support your  Unna boot service (29580, Strapping; Unna boot)  with a documented and applicable diagnosis, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. Most payers will cover the procedure for a very limited number of diagnoses, including fractures of the tarsal and metatarsal bones (825.30-825.35) and lower-extremity ulcers (707.12-707.15).

Some payers will accept additional diagnoses, such as strains of the ankle and foot (845.00-845.19).

Best advice: Covered diagnoses for Unna boot applications vary greatly from insurer to insurer, so you-ll have to look to your individual payer for guidance. Payers often update their policies on the different diagnoses. So you-ll want to check with them from time to time for any additional updates/information, Hvizdash adds. Unsure? Get a Waiver If the surgeon provides an Unna boot for indications or diagnoses that the payer does not approve (for instance, the surgeon may use an Unna boot as a leg wound dressing in some cases), you should ask the patient to sign a waiver (for Medicare, an advance beneficiary notice, or ABN).

You should ask for the waiver before providing the service. The waiver will make the patient aware that he--rather than the insurer--will be responsible for the cost of the service. Report E/M With Caution In most cases, you should not report an E/M service at the same time as an Unna boot application. For instance, guidelines set forth by Cahaba, a Medicare contractor in Alabama, Georgia and Mississippi, specifies, -Unless a separate and distinct service is performed other than CPT 29580, an E/M in addition to CPT 29580 is noncovered.-

If the patient has a new or different complaint that necessitates a separate and significant E/M service, however, you may report an appropriate E/M service (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended, Hvizdash says. You should attach a separate diagnosis to the E/M service to further differentiate it from the -inherent- E/M service included in the Unna boot application.

Report Debridements Separately If a surgeon provides debridement prior to applying the Unna boot, you may report the debridement separately (for example, [...]