29580 vs 29581/ 29583

ahuffine

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We have a pt that had the following applied to both lower extremities and upper extremities. The billing came through as 29580 but I questioned this code being used for the upper extremities and thought 29583/29584 would be more appropriate. I asked if they did the same treatment and used the same supplies for both and they said yes. This is what was used:

Application:
1) Unna boot wrap, the wrap is covered in zinc oxide.
2) Kerlix, gauze like wrap.
3) Coban, Ace bandage like wrap that sticks to itself.
4) Stockinette Tubular Ortho, a tube sock like wrap/material that we cut to size.

So then I questioned if we are even using the right code for lower extremities (29580) or should we be using 29581/29582 given the 4 layers?

Please help!
 

thomas7331

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In my experience, the multi-layer compression dressings that would be appropriate for coding 29581-29583 are different from this - they are usually brand-name dressings that are manufactured specifically for this purposes (e.g. Profore, Dyna-Flex). I guess in theory your provider could be creating their own compression dressing with these materials, but it sounds to me that they're more likely using the gauze and wraps to secure the Unna boot. You might discuss it with them to get clarification but I think in the absence of documentation stating that it is a compression dressing, 29580 is more appropriate.
 

CatchTheWind

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Just note that some payers (Florida Medicare, for example) don't pay for Unna boot on the arms. When I've had a doctor apply an Unna boot on the arm, I had to just include it in the E/M.
 

ahuffine

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Thank you for the feedback. Another question: Our CMA applies the Unnaboot not our doctors - just double checking this is appropriate.
 

gr8gal61

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Most unna boot(s) & or compression wraps are placed by the nurse. The MD must sign and the placement of the boot/wrap needs to be documented. If this is the only service that is performed, typically and E&M is not warranted. We bill for them and get paid. If your state does not allow, I would still bill it and use the GY modifer. Be sure to use RT or LT and for the group I code for, if it is bilateral we use 50 modifier with 1 unit.



Thank you for the feedback. Another question: Our CMA applies the Unnaboot not our doctors - just double checking this is appropriate.
 
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