Home Healthcare Billing Procedures

							                                                                        Practice Name
PatientName:                                                                                           Date of Service:
Date of Birth:                                      SSN:                                               Place of Service:
Payment Amount:                    $                                    CA         CC        CK        Insurance:
PCP/Attending MD:                                                                     Date Last Seen (must be w/in last 6 months):
Dx Codes 800.00-995.0:                      Auto         Employment                Other               Date of Injury:
         New Patient Office             Established Patient Office         New Patient Rest Home         Established Pt. Rest Home         Prolonged Services/Post Op
[   ] 99202 20 min                   [ ] 99212 10 min                  [ ] 99324 Low                   [ ] 99334 Straightforward         [ ] 99354 First Hour
[   ] 99203 30 min                   [ ] 99213 15 min                  [ ] 99325 Straightforward       [ ] 99335 Low                     [ ] 99355 Each addtl 30 min
[   ] 99204 45 min                   [ ] 99214 25 min                                                                                    [ ] 99024 POST OP VISIT
                  Incision & Drainage                               Orthotics Continued                                          Diagnosis Codes
[   ] 10060 I & D Abscess                            [ ] L3260 Surgical shoe                           078.19 Oth Spcfd viral warts      726.72 Tibialis tendinitis
[   ] 10061 Complicated/multiple                     [ ] L4386 Walking boot                            110.1 Dermatophytosis nail        726.79 Ankle enthesopathy
[   ] 10080 Drain pilonidal cyst                                       Diabetic Shoes                  110.4 Dermatophytosis foot        726.91 Exostosis, site NOS
[   ] 10120 Remove FB                                [ ] A5500 Shoe Fitting                            216.7 Benign neoplasm leg         727.06 Tenosynovitis foot/an
[   ] 10160 Puncture drainage                        [ ] A5513 Multi Density Insert                    238.1 Neoplasm soft tissue        727.1 Bunion
[   ] 10140 Drain Hematoma                                       Cast Application/Strapping            274.0 Gouty arthropathy           727.40 Synovial cyst NOS
                      Debridement                    [ ] 29405 Appl short leg cast                     355.0 Sciatic nerve lesion        728.71 Plantar fibromatosis
[   ] 11040 Skin partial thickness                   [ ] 29515 Appl LE splint                          355.5 Tarsal tunnel synd          729.5 Pain in limb
[   ] 11041 Skin full thickness                      [ ] 29540 Strapping ankle/foot                    355.6 Plantar nerve lesion        733.93 Stress fx tibia/fibula
[   ] 97597 Wound care                               [ ] 29580 Unna boot                               355.8 Mononeuritis leg nos        733.94 Stress fx metatarsals
                Pair/Cut Corn & Callus                                      X-Ray                      459.9 Circulatory disease         734 Flat foot
[   ] 11055 One                                      [ ] 73600 Ankle 2 views                           692.4 Chemical dermatitis         735.0 Hallux valgus
[   ] 11056 2-4                                      [ ] 73620 Foot op & lateral                       700 Corns & callosities           735.2 Hallux rigidus
[   ] 11057 4+                                                     Surgical Procedures                 701.1 Keratoderma Acq             735.4 Other hammer toe
              Excision Benign Lesions                [ ] 20924 Rem tendon-graft                        701.4 Keloid scar                 736.70 Acq ankle-foot def NOS
[   ] 11420 0.5 cm or less                           [ ] 27695 Repair ankle ligament                   703.0 Ingrowing nail              736.79 Acq ankle-foot def NEC
[   ] 11421 0.6 - 1.0 cm                             [ ] 28002 I & D infection                         703.8 Disease of nail NEC         736.81 Unequal leg length
[   ] 11422 1.1 - 2 cm                               [ ] 28008 Faciotomy foot/toe                      707.13 Ulcer of ankle             780.8 Gen hyperhidrosis
[   ] 11423 2.1 - 3 cm                               [ ] 28011 Tenotomy                                707.15 Ulcer other part foot      782.3 Edema
                        Nail Care                    [ ] 28060 Part rem foot fascia                    709.8 Skin disorders NEC          824.2 Fx lateral malleolus-cl
[   ] 11720 Debride 5 or less                        [ ] 28080 Exc Morton neuroma                      714.0 Rheumatoid arthritis        826.0 Fx phalanx foot-closed
[   ] 11721 Debride 6 or more                        [ ] 28090 Rem foot lesion                         716.17 Arthropathy ankle trau     844.9 Sprain knee & leg
           Wart /Benign LesionRemoval                [ ] 28110 Part rem metatarsal                     718.20 Path dislocat-unspec       845.00 Sprain ankle
[   ] 17110 Wart Dest to 14                          [ ] 28124 Part removal toe                        719.47 Joint pain - Ankle         845.10 Sprain foot NOS
                      Nail Removal                   [ ] 28208 Repair foot tendon                      719.67 Joint symptom ankle        924.10 Contusion lower leg
[   ] 11730 Avul nail plate, 1                       [ ] 28285 Repair hammertoe                        726.70 Ankle enthesopathy         928.3 Crushing injury toe
[   ] 11732 Each addtl plate                         [ ] 28288 Part rem foot bone                      726.71 Achilles tendinitis        V72.84 Preop exam unspec
[   ] 11750 Exc nail matrix                          [ ] 28289 Cheilectomy                                 Systemic Diagnosis Codes- Bold requires DLS & Ref MD
[   ] 11765 Exc nail fold, toe                       [ ] 28292 Keller/McBride                          250._____ DM II w/o Comp          459.81 Venous insufficiency
                Layer Closure Wound                  [ ] 28296 Austin bunionectomy                     337.1 Aut neuropathy other        459.9 Circulatory disease
[   ] 12041 2.5 cm or less                           [ ] 28298 Correction bunion                       356.4 Idio prog polyneurop        681.10 Cellulitis toe nos
[   ] 12042 2.6 - 7.5 cm                             [ ] 28308 Osteotomy MTH                           451.2 Thromb L.E.                 681.11 Onychia toe
                  Injection/Aspiration                              Other Procedure(s)                                       Other Diagnosis Codes
[   ] 20600 Inj sm jnt bursa                         [ ]
[   ] 20605 Inj interm jnt/bursa                     [ ]
[   ] 20612 Inj ganglion cyst                        [ ]                                                                        Class Findings
[   ] 20550 Inj plantar fascia                       [ ]                                               Class A Findings:
[   ] 20551 Inj single tendon                                           Toe Modifiers                  1) Nontraumatic amputation of foot or integral skeletal portion
[   ] 64450 N block other peripheral                       Digit          Left Foot       Right Foot   Class B Findings:
                        Drugs                           Hallux             TA              T5          1) Absent posterior tibial pulse
[ ] J3301 Kenalog _____ mg                             2nd Digit           T1              T6          2) Advanced trophic changes as: hair growth, nail changes,
[ ] J1110 D.H.E. _____ mg                              3rd Digit           T2              T7          pigmentary changes, skin texture, skin color. (3 REQUIRED)
                     Orthotics                         4th Digit           T3              T8          3) Absent dorsalis pedis pulse
[ ] 97760 Orthotic fitting                             5th Digit           T4              T9          Class C Findings:
[ ] 97762 C/O for orthotic                                               Q-Codes                       1) Claudication, 2) Temperature changes, 3) Edema,
[ ] L1901 Ankle, elastic                             [ ] Q7 - 1 Class A Finding                        4) Paresthesias, 5) Burning
[ ] L1902 Ankle gauntlet                             [ ] Q8 - 2 Class B Findings                       Notes to Billing Office:
[ ] L1906 Ankle brace/support                        [ ] Q9 - 1 Class B & 2 Class C Findings
[ ] L3020 Foot insrt long/met
                                                                 Superbill created by Jennifer Evensen 2008