Podiatry Coding & Billing Alert

Question: A new patient reports to the podiatrist complaining of right ankle pain. The provider performs an evaluation and management (E/M) service that lasts 32 minutes and involves low-level medical decision making (MDM). Based on the E/M, the podiatrist performs a computed tomography (CT) on the patient’s right ankle. Our office does not own the CT equipment that the provider used. Final diagnosis was solitary bone cyst, right ankle. How should I report this encounter?

North Dakota Subscriber

Answer: On the claim, you’ll report 73700 (Computed tomography, lower extremity; without contrast material(s)) for the CT scan.

You would also add modifier 26 (Professional component) to 73700 to show that you are only coding for the professional component of the CT scan. Because the office does not own the CT machine, it is not responsible for the costs associated with owning, maintaining, and operating the machine. Therefore, it would only bill for the professional component, which includes the physician’s time and expertise in interpreting the CT scan and making a diagnosis. The facility that owns the CT machine would bill for the technical component, which includes the cost of using the machine.

You would also add 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter) for the E/M service. This code is used for an office or other outpatient visit that requires at least two of these three key components: a detailed history, a detailed examination, and medical decision making of low complexity. The service duration of 32 minutes and the low-level medical decision making (MDM) align with this code.

Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) would be appended to 99203 to show that a significant, separately identifiable E/M preceded the CT scan.

The correct diagnosis for this scenario would be M85.471 (Solitary bone cyst, right ankle and foot).