Recent content by podcoder70

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    Wiki Non-Asterisk systemic diagnosis Denials

    Each jurisdiction has different requirements. For example, Novitas requires documented class findings and the q modifier for routine foot care coverage. However, other jurisdictions only require the q mod for vascular systemic conditions. The medicare advantage plans follow the same rule...
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    Wiki Bonus Structure

    I haven't added this yet, however, for W2 employees be sure that the structure is in contract form and in a policy manual. In CA, when an employee has a bonus structure there are rules in place as to how that is paid out and the frequency of the payout. When an employee is terminated or quits...
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    Wiki Coding for casting and supplies

    Medicare will, in general, pay for the casting supply as well as the application code, this is usually a Q code. Commercial plans, however, often want an A code for cast supplies.
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    Wiki 11055

    Is the provider also debriding said ulcer?
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    Wiki Abscess draining but no incision - cpt code?

    If it was punctured, 10160. Otherwise, if the abscess was simply "squeezed", this would be included in the E/M.
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    Wiki Custom Orthotic Coding Assistance

    That is more than enough documentation to code for 29799 RT and 29799 LT. Not all payers will cover this code. Eventually, you will develop a list of those that do and those that dont. For those that dont, you will adjust the balance denied. The amount you charge is up to you. Be sure the...
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    Wiki Non-Asterisk systemic diagnosis Denials

    Novitas is a funny one...for RFC, they, like all the others want the primary treating provider and approximate date last seen for the diagnosis codes with the asterisk. However, they ALSO want a "referring provider" name entered on all of the claims with non-asterisked diagnosis codes as well...
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    Wiki Custom Orthotic Coding Assistance

    Unfortunately, there is no ICD10 code specific to this situation. Coverage for orthotics depends on the payer. For example, Medicare and Medicare Advantage plans do not cover them, neither does UHC, Aetna has limited coverage for very specific diagnoses, and Cigna is a big question mark. Blue...
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    Wiki 11055-11057 Dx Issues - HELP!

    FCSO has a very interesting LCD/Article for routine foot care. I don't believe L84 is the issue with your claim. Most likely it is missing other details. Can you please provide the exact denial code you are getting? Is it the same for all claims? Are all claims for diabetes? Please provide...
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    Wiki hallux ulceratioin

    Vanessa, the reason you are having difficulty has more to do with the lack of necessary detail in the note to properly code. The diagnosis states the wound is deep to subq tissue, however, the debridement does not state to what depth the wound was debrided. In addition, there is no...
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    Wiki California Pre-Certification of Surgery - who is responsible?

    The answer is both...the surgeon needs to prior authorize the procedure whereas the hospital prior authorizes the OR, anesthesiologist, etc.
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    Wiki Therion allograft placed "into" the surgical site

    I always advise my clients to not follow advice provided by reps.
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    Wiki Therion allograft placed "into" the surgical site

    I need to apologize for my original reply, I had not fully read the question. The 15275 and 15004 are for placement on the skin. Placement of allograft in the surgical scenario, as described, is included in the primary procedure.
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    Wiki 97597 and 97610 performed in home

    Please help me find information as to the coding rules for these "sometimes" therapy codes as related to treatment provided by an MD or FNP NOT employed by the home health agency. The two codes are being denied, the diagnosis codes are not the issue. POS is 12. Patients are being followed by...
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    Wiki URGENT! NEED CPT FOR TALONAVICULAR CHEILECTOMY

    I believe this to be a bone excision, exostectomy, not a cheilectomy.
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