Podiatry Coding & Billing Alert

Question: I have received tons of conflicting information regarding codes 29540 and 20550. I've been told they are bundled together but have been told they're only bundled if the doctor uses the same diagnosis code for both procedures. For example, if I bill 20550 with 726.90 and 29540 with 728.71, I attach modifier 59. Is this correct?

Tennessee Subscriber

Answer: For a payer that follows Correct Coding Initiative (CCI) edits, you should be able to report both procedures provided your documentation supports that the procedures are separate and distinct.

CCI bundles 29540 (Strapping; ankle and/or foot) into 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]). In this case, 20550 is the column 1 code -- the more extensive procedure -- which includes the column 2 code -- the lesser procedure (29540).

If your podiatrist performs a related tendon sheath or ligament injection on the same day as the patient undergoes a strapping to her ankle or foot, you should report only the injection. CCI assigns the bundle a modifier indicator of "1," which means that you can break the bundle using a modifier in certain clinical circumstances.

If the documentation shows that your podiatrist performed the injection and the strapping at different anatomical sites, during different patient encounters, or for different clinical/diagnostic reasons, you can report both the strapping and the injection. Append modifier 59 (Distinct procedural service) to 29540.

Best bet: If your payer doesn't follow CCI edits, you may be out of luck. However, unless your payer has a specific written guideline that bans the dual reporting of the injection procedure and strapping, you should try an appeal.