practice management

Coding Briefs

APMA's Coding Briefs offer valuable insights and guidelines that navigate podiatrists through appropriate coding. This information is aimed at increasing coding accuracy, ensuring compliance with regulations, and improving documentation, all of which may help to reduce the burden of denials.

APMA has Coding Briefs on the following topics:

  1. Evaluation and Management
  2. Global Periods
  3. Hardware Removal
  4. Imaging Services Billing
  5. Nail Surgery
  6. Routine Foot Care (also known as "At-Risk Foot Care")
  7. Wound Care
  8. -Z Codes

Evaluation and Management

  • When to Submit an E/M with At-Risk Foot Care
    When performing covered, at-risk diabetic foot care, an evaluation and management (E/M) may also be submitted if an E/M is performed that is significant in nature and separately identifiable from the foot care service, provided all of this is supported in the documentation. This may include managing neuropathy by altering, continuing, or prescribing new therapy. This can also include managing a pedal deformity by providing education regarding padding options or discussing options for surgical repair.
     
  • Billing an Imaging Service and an E/M on the Same Day
    Visit the section on Imaging Services Billing. 

To learn more about E/M coding, visit APMA's E/M Resource Page.


Global Periods

When and Why: Importance of CPT ® 99024
Use CPT® 99024 for most postoperative encounters occurring during the 10- or 90-day global period that accompanies a procedure or surgery.   Many providers do not submit this CPT code because there is no direct reimbursement associated with it.  However, it is important to document these encounters and submit CPT 99024 as it is an important source of information the AMA RVS Update Committee and CMS use for reference to build in the value of post-op care to surgical and procedural codes.  If they see no post op encounters submitted, they can argue for a decreased RVU assuming the provider is not seeing the patient and providing care during the global period.  


Hardware Removal

Hardware Removal
When choosing hardware removal codes, providers often must select between CPT® 20670 (Removal of implant; superficial (e.g., buried wire, pin, or rod) (separate procedure))* and CPT® 20680 (Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod, or plate))* for services that do not fall under a global period. For removal of hardware such as a K-wire from a previous bunionectomy, under local anesthesia in an office setting, CPT® 20670 is appropriate. If more complex hardware removal is performed in an outpatient setting, such as removing a buried screw from a previous medial malleolar fracture repair, then CPT® 20680 is appropriate.

*CPT® 20670 includes the words "separate procedure" and thus cannot be submitted as part of another procedure performed at the same anatomical site. Providers should also know the number of units of these codes submitted should relate to the number of anatomical sites addressed. For instance, removal of a buried plate with four screws through one incision would be submitted as one unit of service.


Imaging Services Billing

Billing an Imaging Service and an E/M on the Same Day 

Multiple third party payers are more strictly enforcing documentation requirements associated with submission of radiology services. When both a radiology CPT® code and E/M service are submitted for the same patient on the same day, both an order for the imaging and a full written interpretation must be documented. The order documentation should include the patient’s name, the study being ordered, anatomy being addressed, number and type of views, the clinical indication(s) for the imaging, and the ordering provider’s name and signature. The interpretation documentation should include all findings, both pertinent to the chief complaint and not pertinent to the chief complaint, and what decisions were made as a result of the imaging. 

Learn more about this topic at the upcoming webinar, Radiology Services: Coding and Documentation, taking place April 14, 2026, at 8:00 p.m. ET.


Nail Surgery

  • When to Use CPT ® 11750 versus CPT ® 11730 or 11732
    Use CPT 11730 for a temporary nail plate avulsion and CPT 11732 for any additional temporary nail plate avulsion (add-on code) performed at the same encounter.
    CPT 11750 is used for a permanent nail plate avulsion. This code is the same for the initial and all additional permanent nail plate avulsions performed at the same encounter.
     
  • Nail Avulsion
    If a partial or complete nail avulsion is performed on more than one toe at the same encounter, the second avulsion is represented by CPT® 11732 (Avulsion of nail plate, partial or complete, simple; each additional nail plate) added to CPT® 11730. As CPT 11732 is an “add-on” code, no 59, 51, or X- Modifier should be used in this scenario. Anatomic Modifiers (TA-T9) should be used.
     
  • Biopsy of Nail Unit
    CPT® 11755—Biopsy of nail unit (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure). The AMA CPT Editorial Panel states this code is not intended to be reported when obtaining nail clippings or nail bed scrapings for purposes of performing a fungal culture, KOH preparation, stain or test, or PAS stain. Use of this code typically represents obtaining a through-and-through portion of nail plate and nail bed or a sampling of the proximal nail fold and nail matrix. There is no CPT code to represent obtaining a sample of nail clippings and subungual debris to be sent for pathologic / microbiologic evaluation.

Reference: Page 4, December 2002 CPT Assistant Newsletter 


Routine Foot Care (At-Risk Foot Care)

  • Bundled Services & Routine Foot Care? 
    How can a podiatrist submit the coding for debridement of a right 2nd toenail and paring of a callus on the dorsal aspect of the right 2nd toe PIPJ? 
    - CPT® Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus) 
    - CPT® Code 11720 – Debridement of nail(s) by any method(s); 1 to 5
     

    The CMS 59 Modifier Article states: “Modifier 59 may be reported with code 11720 if one to five nails are debrided and a hyperkeratotic lesion is pared on a toe other than one with a debrided toenail?or?the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which a nail is debrided.” 

Line 1: 11055 - Q8 
Line 2: 11720-59, Q8 

However, if the callus was at the distal tip of the right 2nd toe (not proximal to the?distal interphalangeal joint)?and the right 2nd mycotic toenail was derided, both services could not be submitted. 

  • Trimming Versus Debridement
    When choosing treatment codes for nail care, providers must choose between nail “trimming” codes and nail “debridement” codes.  When considering these codes, trimming refers to a reduction in length while debridement refers to a reduction in size and girth.
     
  • When to Submit an E/M with Routine Foot Care?
    Visit the section on Evaluation and Management. 

Learn more and find resources related to billing routine foot care with the -59 modifier via APMA's -59 Modifier Toolkit.


Wound Care 

  • Lesions 
    CPT® 11305–Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less.
    The CPT Professional book explains that use of this code is reserved for sharp removal of epidermal and dermal lesions. The CPT book also states this sharp removal may be performed by transverse incision or horizontal slicing. When using this code, it is important to differentiate between “removal” and “paring.” This code is not intended to represent shaving to reduce the thickness of a callus. This code is not intended to represent debridement of an ulcer.
     
  • Multiple Procedures at Same Encounter
    When treating an ulcer on the lower limb that is secondary to chronic venous insufficiency or lymphedema, it may be necessary to perform ulcer debridement and apply lower limb compression at the same site at the same encounter. All of the ulcer debridement CPT® codes (CPT 97597, 97598, 11042-11047) are paired with the Unna boot / multi-layer compression CPT codes (CPT 29580 / 29581) by the NCCI PTP edits with the ulcer debridement codes in column 1 of the pairing. When two services are performed at the same site at the same encounter, and the codes that represent those services are paired by an NCCI PTP edit, only the column 1 code of the pairing is submitted. In this situation of both services performed at the same site at the same encounter, appending a 59 Modifier to CPT 29580/ 29581 is inappropriate unbundling of the NCCI PTP edit. 
     
  • Wound Debridement
    When choosing wound debridement CPT® codes (CPT 11042–11047), the code is selected based on the deepest depth of tissue removed and the surface area of the wound. The deepest depth of tissue removed may not necessarily be the deepest depth of the wound. Reference: CPT® Professional Learn more about debridement codes and get more guidance with the APMA Coding Resource Center

-Z Codes

Coding Brief - Z Codes in ICD-10-CM, Do Not Overlook Them!
Z codes within the ICD-10-CM code set capture a wide range of factors that are important to the patient’s health but may not necessarily indicate a specific disease state. Some examples include: Z89.421 (Acquired absence of other right toe(s)), Z99.3 (Dependence on wheelchair), Z59.02 (Unsheltered homelessness), and Z70.01 (Long term (current) use of anticoagulants).  While these codes are rarely submitted alone and should not be the primary diagnosis code, utilizing Z codes is important in some value-based payment models, captures data for analytics and utilization, and for some hospital and health-system employed podiatrists, documenting AND coding social determinants of health via Z codes may be a “pay for performance” item in the physician contract.

 

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