Today's Wound Clinic - Winter 2008 - (Page 15) inBusiness Pertinent Text Unna boot (Procedure code 29580) Unna boot is a paste bandage that consists of gauze that has been impregnated with zinc oxide, gelatin, glycerin, and sometimes calamine. The bandage is applied to the leg from the toe to the knee by overlapping wraps of impregnated gauze. The Unna boot forms a semi rigid soft cast that should be left in place for 4 to 7 days. The Unna boot bandage restricts the volume of the leg, controls edema, and encourages more normal prograde venous blood flow with reduction in the subcutaneous blood pressure. The net effect is improved healing of venous stasis ulcers of the lower extremities. Medicare will consider the use of the Unna boot bandage medically reasonable and necessary for the following indications: • To treat venous vascular insufficiency; • For the treatment of ulcers with and without inflammation of the lower extremities which are caused by increased venous pressure, venous insufficiency or capillary dysfunction; and • For the management of sprains, dislocations, and minor fractures. It is not expected that Unna boot application would be done more often than once or twice per 7 days. Unna boot application is not indicated for use with ulcers resulting from arterial disease or diabetes. An Unna Boot is a dressing used to treat varicose ulcers of the lower extremities, which are due to increased venous pressure, venous insufficiency or capillary dysfunction. It also is used in the management of lymphatic edema, sprains, strains, minor fractures, and as a protective bandage for grafts on burn wounds. It is not effective for ulcers resulting from arterial disease or diabetes. Unna Boot consists of a bandage impregnated with a paste, made from gelatin, zinc oxide, and glycerin. This bandage is layered on the leg ulcer until the bandage becomes rigid. The resulting pressure and bacteriostatic properties assist in healing. Indications: 1. The placing of an Unna boot is covered for treatment of leg ulcers due to venous insufficiency or those instances where there are acquired or congenital microthromboses resulting in non-healing ulcers. 2. For all payable places of service, CPT code 29580 is payable when personally performed or applied by the physician or nonphysician practitioner when billing under their own PIN. It also is payable when done by a nonphysician provider in an office setting (under the “incident to” provision). Limitation: 1. If performed by nursing staff, it is considered a Part A service in the hospital inpatient or outpatient settings where the nurse is employed by the hospital. Coding Guidelines: 1. The guidelines of the Correct Coding Initiative supersede all coding instruction in this LCD. 2. The diagnosis code(s) must best describe the patient’s condition for which the service was performed. 3. CPT code 29580 represents the Unna boot service or application only; it is not to be used for billing other strappings or dressing changes. 4. CPT code 29580 has a global period of 0 days. An E&M code can be billed in addition, when the initial evaluation of the condition leading to a decision to apply the Unna boot is done. A subsequent E&M code for an established patient should not be billed when repeat Unna boot application is done, unless an unrelated separately identifiable E&M service is performed. In this case, modifier -25 must be used with the E&M code. 5. When an Unna boot is applied to one extremity, use the appropriate RT or LT modifier to indicate which leg is affected. 6. When billing the Unna boot for both legs, use the -50 modifier to indicate that this service is bilateral, and list 1 as a number of service (modifiers RT and LT are not necessary in this situation). This will indicate that the Unna boots are being applied to both legs. 7. Services may be provided in the office (11), home (12), assisted living facility (13), urgent care facility (200, inpatient hospital (21), outpatient hospital (22), ambulatory surgical center (24), skilled nursing home for patients in a Part A stay (31), nursing facility for patients not in a Part A stay (32), custodial care facility (33), independent clinic (49), inpatient psychiatric facility (51), psychiatric residential treatment center (56), comprehensive inpatient rehabilitation facility(61),and a state or local public health center (71). NOTE: POS 32 will be considered payable only when billed by a physician. When performed by an occupational or physical therapist in this place of service, payment will be denied. Today’s Wound Clinic Winter 2008 15
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