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In my opinion, this can be coded by either of your approaches. 1) CPT 12020-79 is used for the treatment of superficial wound dehiscence; simple closure; or 2) 99212 with a 24 modifier to indicate that the E&M was performed during the global post-op period (although amputations do not have global post-op period)

Billed 28825 for initial amputation of distal phalanx. No global period. I assume follow up visits could warrant an E/M code. I will just use the E/M code.

If you billed 28124 then you have a 90 day global that needs to be addressed. The question I would want you to answer, to protect you in case of audit, is there a return to the same type of OR required where the intial procedure was performed? If not, that is problematic. And can you really document that this was an unexpected complication from the original surgery? Just performing and documenting what you did w/o referencing that this outcome was not an unexpected complication of the previous sx may result in a recoupment on audit. My gut feeling here, is that this is actually a compication of the original surgery and that cleaning the wound and putting in three simple sutures is part of the post op experience and there should be no bill. Your other options are (again with those caviots noted) Billing the appropriate level e/m w/24 modifier or biling 12020 with either a 78 or 79 modifier Bear in mind the following rules for the modifiers: Modifier 78 is used to report an unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure during the post-operative period. Modifier 79 is used to indicate an unrelated procedure that was performed by the same physician or other qualified health care professional during the post-operative period.

If you mean Medicare is primary, then bill Medicare DMERC A5500GYRT and A5500GYLT. This billing will be denied as not covered because the patient already received their Medicare benefit. Another option is A5500GART and A5500GALT, this tells the Medicare DMERC that an ABN was provided. Because they already received their annual benefit, this notifies the Medicare DMERC carrier you notified the patient in advance of non coverage as the therapeutic policy only allows one pair per calendar year. Once you receive the EOB from Medicare, it should have a PR code meaning patient responsibility, then bill the secondary insurance for payment for the second pair.

You need to look at the evidence that is out there not what a speaker states or puts in writing in their opinion. One must back things up with facts. CPT Case studies outlines CPT 28285. In the publication, they describe a hammertoe repair. Preservice is related which is everything that leads to the actual time of incision. Then you see they provide the "Intraservice" explaining the surgery, in no way does CPT describe the metatarsal phalangeal joint as part of the typical or integral to the procedure. CPT Assistant Nov 98:8, May 06:18, Sept 10:9, Sept 11:11 are the references they use. If a patient has deformity at the MTPJ meaning a contracture involving the capsule, the flexor plate (Flexor tendons) you perform a MTPJ tenotomy with capsulotomy as described by CPT 28270. It is designated as a (separate procedure), CPT defines this "when a procedure or service that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct from other procedures/services provided at that time, it may be reported by itself, or in addition to other procedures/services by appending modifier -59 to the specific "separate procedure" code to indicate that the procedure is not considered to be a component of another procedure, but is a distinct, independent procedure. This may represent a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries)." The most appropriate diagnosis is either M24.574 Contracture, right foot or M24.575 Contracture, left foot. Of course you would have documented this pre-operatively and in the operative report. Another option at MTPJ may involve tissue transfer or rearrangement (eg, Z-plasty, W-plasty, V-Y plasty, rotation flap, advancement flap). These codes fall in Adjacent Tissue Transfer or Rearrangement (CPT 14020-14350). As one can see these are soft tissue procedures making the statement by the speaker inappropriate.