Part B Insider (Multispecialty) Coding Alert

Published on Wed Jul 26, 2006 PDF

You may not be able to bill 29540 by itself

If you report 29540 (Strapping; ankle and/or foot) when your podiatrist performs it in conjunction with fracture care, injury or dislocation treatment, you-re coding incorrectly. Follow our advice to determine how you can unbundle the code when the physician performs multiple procedures.

CPT guideline: You can separately report 29540 -when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient.- Unfortunately, payors have yet to form a consensus for interpreting this guideline.

Example: The podiatrist performs a cortisone injection for plantar fasciitis (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]) and then uses strapping to further alleviate pain. You may be able to collect for both procedures because a cortisone injection is not really -restoring- the plantar fascia, and because the injection and the strapping provide different therapeutic effects.

What to do: National Correct Coding Initiative edits make 29540 a component of 20550, so to bypass bundling, list 20550 in line 1 of box #24D of the claim form, and then list 29540 with modifier 59 (Distinct procedural service) appended on line 2 of box #24D. Modifier 59 informs your payor that these are two separate services. Be sure to link both procedure codes to the same diagnosis code, 728.71 (Plantar fascial fibromatosis).

Not all payors agree: If the podiatrist does not perform the strapping with a -restorative treatment,- you should have a chance at reimbursement, but your payor may disagree on your definition of restoration.

Unless your payor has a specific written guideline that bans the dual reporting of the specific nonrestorative procedure and strapping, you may opt to move forward with an appeal.