Today's Wound Clinic - Winter 2008 - (Page 17) inBusiness Pertinent Text 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 places of service, CPT code 29580 is payable when personally performed or applied by the physician or non-physician 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). Limitations 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. Article Text: 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 (31a), 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), state or local public health center (71). 8. The reimbursement for CPT code 29580 includes the supplies and the service. a. This place of service 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. Strapping; Unna Boot (CPT code 29580) A dressing for ulcers resulting from venous insufficiency, consisting of a paste made from gelatin, zinc oxide, and glycerin, which is applied to the leg then covered with a spiral bandage, this in turn being given a coat of the paste. The process is repeated until satisfactory rigidity is attained. Today’s Wound Clinic Winter 2008 17
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