E/M During Global Period for Diabetic Foot Ulcer Following Total Metatarsal Amputation

Question:

If a patient has a total metatarsal amputation for diabetic foot ulcer and he gets readmitted for another condition, but then vascular surgery is consulted for his original underlying condition of DFA and now is treating the ulcer at the amputation site, 80 days post-op is the E/M billable? The TMA surgical wound is healing. The right plantar DFU stage 3 Wagner needs debridement and dressing changes.

Answer:

The evaluation and management service is not separately billable because it appears to represent continued management of the same surgical and disease process that prompted the original total metatarsal amputation. Any care directed toward the amputation wound or related diabetic ulceration in the same region during the 90-day global is included in the global period.

*This response is based on the best information available as of 11/20/25.

Clarifying +G2211

Question:

My question is whether +G2211 is appropriate for vascular surgeons. Since the code has now been implemented, I’m wondering if it’s considered appropriate for those of us who manage long-term vascular patients over several years to use this add-on code until further guidance or changes occur.

Answer:

The add-on code +G2211 is not restricted by specialty and may be reported by any provider when the visit meets the required criteria. However, many interpretations suggest that the intent of the code is more closely aligned with primary care and the ongoing, relationship-based management of chronic or complex conditions, rather than procedural or single-episode care.

To use +G2211, the encounter must involve an office or outpatient E/M service (99202–99215) and reflect longitudinal or continuous care for a serious or complex condition. Documentation should support that the provider serves as a continuing focal point in the patient’s management and that the care provided extends beyond routine or acute treatment.

Because the code allows interpretive flexibility, its use in procedural specialties may carry a higher risk of audit or scrutiny.

*This response is based on the best information available as of 11/06/25.

Catheter with Angioplasty Procedure

Question:

If a third-order catheter is pulled back and enters the iliac, which is then treated with angioplasty, can you code that selective iliac catheterization in addition to the angioplasty?

Answer:

​No, because catheterization is inclusive to lower extremity arterial revascularization interventions, such as an arterial angioplasty and stenting. Report the angioplasty only.

*This response is based on the best information available as of 10/23/25.

How Do You Bill for H&P on the Same Date as an EVAR?

Question:

I saw a patient in the office, performed an examination, and scheduled an EVAR for the next week in the hospital.  The day of surgery, the hospital requires that I document an H&P on the day of the procedure. Can I bill an E/M for the required H&P?

Answer:

Thank you for reaching out to KZA! Because the EVAR procedure has a 90-day global period, it is considered a major procedure.  You cannot bill a separate E/M service for the history and physical on the day of the EVAR procedure if it's solely the pre-procedure H&P required for hospital admission/surgery.

Chapter 1 of the National Correct Coding Initiative states: “If a procedure has a global period of 90 days, it is defined as a major surgical procedure. If an E&M is performed on the same date of service as a major surgical procedure for the purpose of deciding whether to perform this surgical procedure, the E&M service is separately reportable with modifier 57. Other E&M services on the same date of service as a major surgical procedure are included in the global payment for the procedure and are not separately reportable”

*This response is based on the best information available as of 10/09/25.

Reporting Modifiers with Unlisted Codes

Question:

Can modifiers be reported with unlisted CPT codes?

Answer:

Yes, modifiers can be appended to unlisted CPT codes.

In 2024, CPT clarified this by updating the introduction guidelines for unlisted procedures and services. These updates were further explained in the January 2024 issue of CPT Assistant, which addressed the new and revised text and the standardization of reporting unlisted CPT codes across the CPT code set.

Illustration of modifiers that may be appropriately applied includes:

• Laterality modifiers – e.g., RT (right), LT (left)

• Bilateral procedure modifier – 50

• Role-based modifiers – e.g., 62 (two surgeons), 80 (assistant surgeon), 82 (assistant surgeon when qualified resident not available), AS (non-physician surgical assistant)

• Multiple or distinct procedure modifiers – e.g., 51 (multiple procedures), 59 (distinct procedural service)

• Global modifiers – e.g., 58 (staged or related procedure), 78 (return to operating room for related procedure), 79 (unrelated procedure or service)

This is not an all-inclusive list of modifiers that may be appropriately applied to unlisted CPT codes. For complete and up-to-date information, one should refer to current CPT guidelines and payer-specific policies.

Please note: Modifiers that describe an alteration of a service or procedure, such as modifier 52 (reduced services), are not appropriate for use with unlisted codes. The same applied to modifier 22 (increased procedural services).

*This response is based on the best information available as of 9/22/25.

Angioplasty vs. Stent Placement

Question:

Our providers are using a self-expanding scaffold system that features integrated balloon dilation. This device is designed to temporarily support the artery, widening blockages, but the scaffold is retrieved at the end of the procedure, so no permanent implant remains. Such technology represents an innovation for treating peripheral artery disease, especially in cases with complex, calcified narrowing of lower limb arteries. Given that the scaffold is temporary and removed, my coding research indicates this procedure should be reported as angioplasty. Some device vendors suggest billing as stent placement. Is this accurate?

Answer:

For procedures using a temporary self-expanding scaffold with balloon dilation, where the scaffold is removed at the end and no permanent implant remains in the vessel, the intervention should be coded as angioplasty, not a stent placement. Stent placement codes are reserved for conventional stents that remain in the vessel as permanent implants, in accordance with CPT and major coding guidelines. Angioplasty codes are the correct choice when no permanent stent is left behind.

*This response is based on the best information available as of 9/25/25.