Podiatry Coding & Billing Alert

Be careful while reporting procedures performed with adjacent tissue transfers.

If your podiatrist performs tissue transfers on foot injuries/ulcers, watch out: the Correct Coding Initiative has a few things to say about what you can – and cannot – report with those CPT^® codes.

The latest version of CCI, Version 22.0, is effective as of Jan. 1. Overall, CCI 22.0 introduced more than 55,000 new bundles of CPT^® codes.

All of the CPT^® codes in the “Adjacent Tissue Transfer or Rearrangement Procedures on the Integumentary System” series (14000-14350) now include:

• +11001 – Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)
• 11004-11006 – Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection…
• +11045 – Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
• 11043 – Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
• +11046 – … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
• 11044 – Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
• +11047 – … each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure).

What this means: These CCI edits are all Column 1/column 2 edits, describing “bundled” procedures. The column 1 code generally represents the comprehensive service, and the column 2 code is the component that is part of the more extensive column 1 procedure.

“Column 1 codes are codes that are primarily payable,” says Elizabeth Hollingshead, CPC, CUC, CMC, CMSCS, coding specialist at Central Ohio Urology Group in Marysville, Ohio. “Column 2 codes are the codes that are bundled into the column 1 codes. If they are billed together, the code in column 2 will be denied unless it is has a modifier indicator of 1 and it is appropriate to add a proper modifier to break the bundle.”

If you bill bundled (column 1/column 2) procedures for the same patient on the same day, payers will pay you only for the higher-valued of the two, usually the column 1 code.

However: All of the edits are marked with modifier indicator “1,” which means that you can, under appropriate clinical circumstances, report the two codes separately, along with a modifier (such as modifier 59, Distinct procedural service), appended to the Column 2 code.

These codes may not have a huge impact on your practice, notes Pamela Biffle, CPC, CPC-P, CPC-I, CPCO, owner of PB Healthcare Consulting and Education Inc. in Austin, Texas. The debridement codes are “more relevant in an urgent care or ED situation,” she says.

Don’t miss: CPT^® codes +11001 and +11045 are add-on codes. Both of their primary procedure codes (11000 and 11042, respectively) had already been bundled into 14000-14350. Also, note that +11045 and +11046 appear out of numerical sequence, so as to keep them next to their primary procedure codes (11042 and 11043).

Resource: For more on CCI edits, visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.