Wiki 28003/28005 with 28120, 28122, 28222, etc

[wkb4173]

I am new to podiatry coding. There is a physician billing 28003 and 28005 (which are NCCI bundled with the following)... 28122, 28062, 28222, 28120.... Mostly diabetic foot infection procedures for debridement/incision and drainage.

Is it appropriate to bill the incision portion of the procedure with these other foot codes if there is a 59 modifier? My instinct says no since an incision down to the bone is part of the more extensive procedures.

Also - does anyone know about coding 64450 nerve blocks with these podiatry codes in addition to the use of MAC/local anesthesia?

 

[podcoder70]

Could you provide a portion of the documentation for the i&d/dm foot infx procedures you are referring to?

If you are asking if 64450 should have an anesthesia code with it, the answer is no. If that is not your question, can you please clarify? Thanks!

Tonia

 

[wkb4173]

Hi Tonia!

Podiatry surgeon is billing 64450-59 with each of his procedures, and the anesthesiologist is billing 01480.

Here is one report in which the following codes were billed -- 28315-RT, 28005-59, 28122-RT, 28124-RT, 28232-RT, 64450-59, 11982-59, 97605.

Preoperative Diagnosis (With AJCC Staging as Applicable)
1. Diabetic foot ulcer right foot
2. Osteomyelitis right foot

Postoperative Diagnosis
Same as above

Operation (Laterality as Applicable)
1. I&D down to bone right foot
2. Partial resection of right first metatarsal
3. Partial resection of right proximal phalanx of the great toe
4. Excision of antibiotic cement spacer
5. Excision of tibial and fibular sesamoids
6. Flexor hallucis longus tenotomy with resection
7. Application of wound VAC right foot
8. Peripheral nerve block of the right deep peroneal nerve, superficial peroneal nerve, medial plantar nerve

Anesthesia - MAC/LOCAL Approx 10 cc of quarter percent Marciane plain

Description of Operation
The patient was brought to the operating room placed on the operating table in the supine position. After induction of
anesthesia, utilizing the aforementioned local anesthetic the right lower extremity was anesthetized and subsequently prepped
and draped in the usual aseptic fashion.
Methylene blue was injected through the sinus tract and open ulceration into the deep cavity and after this an incision was made
down to the level of bone and necrotic nonviable tissue was debrided to the best of our ability in an excisional type fashion. Predebridement
soft tissue cultures were taken and sent to microbiology for analysis. The antibiotic cement spacer was removed
from within the cavity and the base the proximal phalanx as well as the distal portion of the first metatarsal of the right foot were
resected and specimens from them were sent to pathology as well as microbiology for analysis. The tibial and fibular sesamoids
were further resected at this point in a transverse tenotomy the flexor hallucis longus was made and the tendon was resected
proximally and excised. After debridement of necrotic nonviable and dyed tissue utilizing rongeur, curette and versa jet the
wound was copiously irrigated utilizing 3 L of sterile saline. Post debridement soft tissue cultures were taken and sent to
microbiology for analysis. A wound VAC was placed into the defect at the end of the case and the right lower extremity was
subsequently dressed utilizing dry, sterile dressings for padding.

 

[lipstick]

Wow. I do not think you can bill for the wound VAC since it was placed during the surgery nor for the nerve block. There's a lot going on in this note. I do not see where cpt 28005 was performed.