Wiki Billing TCC 29445 and 11042 together

[csparks1988]

I am receiving conflicting information and need a specific guideline that tells my physicians they can not bill these together if performed on same site.
our physicians are putting TCC 29445 on DFU pts in wound care outpt setting. This is not a casting, this is being used to off load the wound in order to heal.
can a modifier be added to be able to get both separate procedures paid.

thank you
Christine

 

[thomas7331]

The guideline is stated clearly in the NCCI Policy Manual, Chapter IV, Section G, Paragraph 3

Debridement CPT codes (e.g., 11042-11047, 97597) and grafting CPT codes (e.g., 15040-15776) should not be reported with a casting/splinting/strapping CPT code (e.g., 29445, 29580, 29581) for the same anatomic area.

There is no exception noted for casts used to off-load a wound. If both are performed on the same site and at the same encounter, the use of a modifier to get separate payment would be inappropriate unbundling.