Question and Answers to Help Code Unna Boot Application

Published: 08th January 2011
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Find out why E/M and strapping cannot go together as separate codes

Are you aware that CCI bundles Unna boot application to many other complete surgeries (for instance tendon sheath injections, joint aspiration/injection, and the like)? If you are confused about this and many other questions about coding Unna boot application, the following questions and answers should throw some light.

Question 1: What's the purpose of Unna Boot?

Answer: The New York Medicare carrier National Government Services LCD L6979 Unna boot as a dressing used to treat varicose ulcers of the lower extremities, which are owing to increased venous pressure, venous insufficiency or capillary dysfunction. It comprises a bandage impregnated with a gelatin, zinc oxide, and glycerin paste that the provider layers on the leg ulcer until the bandage becomes rigid.

According to the LCD, the resulting pressure and bacteriostatic properties aid in healing.

Question 2: Do you get the payments for the supplies with Unna Boot?

Answer: You should not think about Unna boots applied as dressings a separately reimbursable service apart from surgical procedure.

As per CCI, payment for surgical dressings applied by the doctor during his/her encounter with the patient is included in the fee schedule payment for the doctor's service.

Medically necessary Unna boots, not applied as post-op dressings make use of the CPT 29580 (Strapping; Unna boot). Just like that, you should never code for any supplies. Payers include the cost of all Unna boot bandages, straps and paste in their payment for 29580.

But then you should report change in dressings every few days, while the patient is in Unna boot, with 29580, which has a global period of zero days.

Question 3: Can I bill an Evaluation/Management with 29580?

Answer: You may report an Unna boot application with 29580 apart from the proper E/M code only under this situation: The boot application is provided as an initial service with no expectation that the doctor who rendered only the original care will carry out another treatment or procedure.

To put it in other words, if the patient has a new or different complaint that requires a separate and significant E/M service, you may bill a proper E/M code. Do not forget to append with modifier 25.

Reminder: You'd need to attach a separate diagnosis to the E/M service to further distinguish it from the inherent E/M service included in the Unna boot application.

Question 4: What if Doc carried out a debridement also?

Answer: Debridement before applying the Unna boot is a typical procedure that podiatrist performs. You can report debridement during the same session as 29580 only if the services apply to separate anatomical areas (separate feet).

Fact: CCI has bundled column-2 code 29580 into column-1 codes 11040-11044 as a standard of medical/surgical practice. The modifier indicator of 1 allows you to report both procedures separately using modifier 59. For instance, the physician carries out a debridement on the patient's right foot and applies an Unna boot to the left foot.

Question 5: What ICD-9 codes should you use with 29580?

Answer: Depending on the payer, 29580 links to diseases like varicose veins of lower extremities (454.0-454.2) and lower limb ulcers, except decubitus (707.10, 707.12-707.19). Some payers will take additional diagnoses, such as atherosclerosis of extremity with ulceration (440.23) or sprains and strains of the ankle and foot (845.00-845.19). Like always, you should report the diagnosis as per your physician's documentation.

Do: Ensure you check with your payer on current policy or update for the different diagnoses.

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