Wiki e/m and unna boot?

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conniff

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hi all,

would you bill for an unna boot (29580) or just an e/m in this case?? or both?

patient returns for unna boot change and evaluation of his left malleolar venous stasis ulcer. We are now measuring the posterior ulcer at 1x0.8cm with no depth and the more anterior ulcer at 2 x 1cm. We will continue with Unna boot, as we are making improvement.
 
Per the NCCI rebundling table, the code for Unna boots is component to many other comprehensive surgeries (e.g. tendon sheath injections, joint aspiration/injection, etc.) unless a modifier is appended to reflect the Unna boot was used in a distinct, separate service. Unna boots applied as dressings would not be considered a separately reimbursable service apart from surgical procedure as payment for surgical dressings applied by the physician during his/her encounter with the patient is included in the fee schedule payment for the physician's service. For medically necessary Unna boots not applied as post operative dressings, CPT code 29580 may be billed; but an evaluation and management visit should not be billed unless there is a distinct, separately identifiable reason for the E&M service. It would be inappropriate to bill an E&M service for the assessment related to Unna boot application. The assessment would be considered part of the pre-procedural evaluation that is component to the procedure/service. This is reflected in the following link to CMS Publication 100-4, The Medicare Claims Processing, Chapter 12, and Section 30.6.6. It explains that each procedure includes a pre-procedural evaluation that should not be separately billed as a distinct, separately payable E&M visit.
 
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