How Will The New Coding Changes Affect Your Practice?

By Billie C. Bradford, MBA
Medicare also presently identifies electromagnetic stimulation to one or more areas (G0295) as a non-covered service. An Update On Coding For Shockwave Therapy In response to multiple requests from CMS contractors to establish a national payment amount, CMS had inaccurately considered CPT Category III Code 0020T for extracorporeal shock wave therapy (ESWT). CMS officials had said that ESWT was “similar to other physical therapy modalities” involving the plantar fascia and had designated it to be paid on the therapy fee schedule. The American College of Foot and Ankle Surgeons (ACFAS) and the American Podiatric Medical Association (APMA) both worked hard to successfully have that inappropriate determination withdrawn from the 2003 Medicare Fee Schedule and re-evaluated. CPT Codes: Key Changes You Need To Know In addition to dealing with the fluctuating dictates from CMS, podiatric practices also are challenged to ensure their adherence to the most current annual changes in CPT codes. Some of the more significant 2003 coding changes that your practice needs to be aware of are presented below. The American Medical Association CPT benign and malignant lesion excision codes guidelines have been changed significantly for CY 2003. Under the new guidelines, one should determine the code by measuring the greatest clinical diameter of the apparent lesion plus the margin required for complete excision. In other words, the lesion diameter plus the most narrow margins required equal the excised diameter. The excised diameter is the same whether you have repaired the surgical defect in a linear fashion or reconstructed it (e.g., with a skin graft). You should report each excised lesion separately. The 2003 malignant lesion guidelines also contain additional coding directives regarding frozen section pathology and any additional excision during the same operative session. Re-excision during the post-op period of the primary excision should include the “-58” modifier. A Heads-Up On Coding For Injections The intent behind the 2003 revisions to the descriptors for the CPT Code Series 20550-20553 was to have physicians report codes 20552 and 20553 one time per session, regardless of the number of injections or muscles they injected. You should report codes 20550 and 20551 one time when you have performed multiple or single injections to a single tendon sheath, ligament, tendon origin or tendon insertion. Report injections to multiple tendon sheaths, tendon origins, tendon insertions or ligaments one time for each injection. The CPT Code 20612 was created this year to separate the aspiration and/or injection of ganglion cyst(s) from Codes 20550, 20600 and 20605. Other Coding Essentials The CPT Code 27870 previously was used to report an ankle arthrodesis performed by any method. However, a code descriptor change in 2003 removed “any method” from the nomenclature to clarify that the code intent involves only an “open” surgical approach. CPT Code 29899 has been added in 2003 CPT to identify the arthroscopic ankle fusion procedure. The CPT Code 29540 for applying strapping has been clarified by a descriptor change that now says you can report the code for “strapping, ankle and/or foot.” The 2003 CPT has also deleted all language within the modifier descriptors referencing the use of five-digit modifier codes (e.g., 09959 can no longer be used as an alternative to modifier “-59”). Ms. Bradford is the Director of the Department of Socioeconomics and Practice Management for the American College of Foot and Ankle Surgeons. She is the author of two textbooks on ICD-9-CM coding for physician offices. For additional information, please contact Ms. Bradford at ACFAS headquarters, 847-292-2237, ext. 322, or via e-mail at or Editor’s Note: For a related article, see “Maximize Your Reimbursement: A Guide To Billing In Diabetic Care,” in the March issue of Podiatry Today or visit the archives at

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