Today's Wound Clinic - Winter 2008 - (Page 21) inBusiness Pertinent Text General Guidelines for Splints and Strapping (CPT codes 29580…) • These codes are not covered for the application of prefabricated (ie, off the shelf) orthotics/splints. CPT 29580 – Unna boot The application of Unna boot paste (zinc, gelatin, or other product) as a bandage or “colloid” dressing, is applied to an extremity for the treatment of dermatological, vascular, and on occasion, other conditions. These dressings are often covered by an elastic bandage to give added support, hold the dressing in place, and provide a protective cover. Unna boot application is appropriate in the treatment of ulcerations with and without inflammation due to stasis dermatitis produced by vascular insufficiency. The Unna boot is also appropriate for treating ligamentous injuries (sprains and strains) of the ankle. Unna boots need to be changed on a regular basis, depending on the exact type used and the indications. Application of Unna Boot (CPT® 29580) • All supply items related to the unna boot are inclusive in the reimbursement for CPT® 29580. High Compression MultiLayered Bandage System • Multilayered, sustained, graduated high compression bandage systems are used primarily to treat lymphedema and venous or stasis leg ulcers. In recent years a number of graduated, high compression bandage systems products have been developed, including PROFORE®*, DynaFlex®† , Surepress®§, Setopress®¶, and other similar product systems. • Application of the high compressing bandage systems is an unskilled procedure, similar to the application of dressings. Like other dressing applications, payment for this service is included in the payment for the E&M or other procedure performed on the same day and application may not be separately billed. Supply charges may be reported under the appropriate revenue codes. Traditional Treatment Using the Unna Boot Patients with chronic leg wounds secondary to venous hypertension or insufficiency are often treated with multi-layered, sustained, graduated high compression bandage systems. The traditional treatment has been with Unna boots applied by the physician, but, as noted above, a number of products and systems have been developed for treatment. However, all of these products, with the exception of Unna boots, can be applied safely by the patient and/or caregiver. Unna boot application has its own CPT code, 29580 (Strapping; Unna boot) while currently application of the high compression bandage systems does not have an appropriate code and must be billed with CPT 29799 (Unlisted procedure, casting or strapping). NAS Policy for High Compression Bandage Systems Noridian Administrative Services (NAS) has noted that providers have been advised to use CPT 29580 when applying one of the high compression bandage systems noted above. NAS Strongly disagrees with this coding advice and requires providers to bill using CPT 29799. Furthermore, since the high compression bandage systems may safely be applied by patient or caregiver, reimbursement for the application or materials used will be denied as not medically reasonable and necessary. Application of paste 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 One of the standard treatments for venous stasis ulcers on the lower extremities is the application of an Unna boot (CPT code 29580). An Unna boot consists of a bandage impregnated with “Unna paste” which is made from gelatin, zinc oxide, and glycerine. This bandage is layered on the leg ulcer until the bandage becomes rigid. The resulting pressure and bacteriostatic properties assist in healing. There are now several commercially available multilayered compression dressings (eg, PROFORE*, PROFORE Lite#) that can be applied instead of an Unna boot. There has been confusion as to how to correctly bill for these new types of dressings because of statements on the manufacturer’s website and article in the CPT Assistant. These new dressings should be billed using CPT code 29799, Unlisted procedure, casting or strapping, and the brand name of the dressing used placed in item 19 or the CMS-1500 or its electronic equivalent. Payment for 29799 will include the application of the dressing and the materials used. The materials should not be billed separately Today’s Wound Clinic Winter 2008 21
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