We cannot submit CPT®[1] coding for both ulcer debridement and total contact cast application when both are performed for the same ulcer at the same encounter.
Direction regarding coding for multiple procedures at the same encounter is provided by the National Correct Coding Initiative (NCCI)[1]. Chapter I, Section A of the NCCI Policy Manual states, “a physician shall not report multiple HCPCS/CPT codes when a single comprehensive HCPCS/CPT code describes these services.”[2]
The NCCI publishes procedure – to – procedure (PTP) edits for certain CPT code combinations. These edits are usually based upon the standards of medical / surgical practice. 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 edit. 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 procedure–to–procedure edits pair CPT 97597/8 and 11042-11047 with CPT 29445, meaning any of these code combinations should not be submitted together unless it is clinically appropriate to use an NCCI PTP-associated modifier. When both of these services are performed, only the ulcer debridement CPT code should be submitted as, when performed at the same site for the same ulcer, the total contact cast application is considered to be an integral component of the debridement. Chapter IV, Section G.2 of the National Correct Coding Initiative Policy Manual5 states:
“Casting/splinting/strapping CPT codes shall not be reported for application of a dressing after a therapeutic procedure.”
[1] 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).
[2] Chapter I, General Correct Coding Policies For National Correct Coding Initiative Policy Manual For Medicare Services
