Question: Can we submit CPT® codes1 for both applications of a below knee, multi-layer compression system and ulcer debridement when both are performed for the same ulcer at the same encounter?
Answer: No
The Source
The National Correct Coding Initiative (NCCI) publishes procedure-to-procedure (PTP) edits for certain CPT code combinations2. When one service is considered to be an integral component of another service, the CPT codes that represent the two services are paired by a NCCI PTP edit3. In general, when a pair of services is provided at the same encounter whose CPT codes are paired by a NCCI PTP edit, both CPT codes should not be reported unless it is clinically appropriate to use an NCCI PTP-associated modifier.
The National Correct Coding Initiative PTP edits pair CPT 29581 with all of the ulcer debridement codes (CPT 9759X and 1104X), meaning any of these code combinations should not be submitted unless it is clinically appropriate to use an NCCI PTP-associated modifier. For these combinations, the only appropriate NCCI PTP-associated modifier that would be appropriate is one which designates the services were performed at different sites.
How To Submit
In all of the NCCI PTP edits that pair CPT 29581 with CPT 9759X and 1104X, CPT 29581 is in column 2, indicating this service is considered to be an integral component of the debridement and only the debridement should be submitted.
Another Option
Compression may also be accomplished with the EXTREMIT-EASE® Compression Garment from AMERX Health Care. If medically appropriate, this compression garment can be relied upon to achieve the compression needed for venous leg disease and most third-party payers allow both ulcer debridement and the supply of this compression garment at the same session.
- CPT 2023 Professional Edition Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2022 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).
- National Correct Coding Initiative Policy Manual For Medicare Services https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd
- Chapter I, General Correct Coding Policies For National Correct Coding Initiative Policy Manual For Medicare Services
Dr. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Dr. Lehrman is a podiatrist practicing in Fort Collins, CO and operates Lehrman Consulting, LLC which provides consultation services regarding coding, compliance and documentation. Dr. Lehrman is a Certified Professional Coder and Certified Professional Medical Auditor. He serves as a staff liaison at the AMA CPT® Editorial Panel meetings where CPT codes are created, edited, and deleted. He is a Diplomate of the American Board of Foot and Ankle Surgery, Fellow of the American Society of Podiatric Surgeons, and is recognized as a “Master” by the American Professional Wound Care Association. Dr Lehrman is a Fellow of the American Academy of Podiatric Practice Management, Past Director of the American Professional Wound Care Association Board of Directors, and is a Past Chairman of the Board of the American Society of Podiatric Surgeons. Dr. Lehrman is also on the editorial advisory board of the journal WOUNDS.
