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  1. K

    Wiki DME Off-the-Shelf vs Customize

    Good evening, If an EXOS brace was heated to fit the patient better, would it be consider customization (because it was molded by heat) or still considered off-the-shelf (because heating isn't enough to be considered "customized")? Thank you!
  2. K

    Wiki Non-Asterisk systemic diagnosis Denials

    Thank you for confirming this! And I'm sorry for adding on to this, but I know Medicare requires the Q modifiers and currently, I just add it on all insurances because the majority follows Medicare guidelines. Do you happen to know if there are commercial insurances that does not require the Q...
  3. K

    Wiki Custom Orthotic Coding Assistance

    You have made my day! lol Thank you so so much!
  4. K

    Wiki Custom Orthotic Coding Assistance

    Hi, this is the documentation for when the patient is scanned for their custom orthotics at our office: "Patient would benefit from custom orthotics. Due to the unique foot structure the patient, a custom orthotic will intimately contour and contact the foot aiding in support of the foot and...
  5. K

    Wiki Non-Asterisk systemic diagnosis Denials

    Hello, I understand that in the CMS A52996 Routine Foot Care reference, the systemic ICDs with the asterisk (*) indicates that a managing provider and an approximate date last seen for the condition is required. I initially thought that the ones WITHOUT the asterisk, for example, I73.9...
    • kle0204
    • Thread
    • non-asterisk icd routine foot care
    • Replies: 3
    • Forum: Podiatry
  6. K

    Wiki 0707T vs ORIF for Traumatic Fractures

    Hello! If the Tactoset Anika Therapeutics Injectable bone graft substitute is used, I know 0707T exists, HOWEVER, Would I be able to use 0707T for traumatic fractures or could it be the ORIF code since a small incision was made prior to injecting the bone substitute directly into the bone...
  7. K

    Wiki 11750 Documentation

    Thank you!
  8. K

    Wiki 11750 Documentation

    Good afternoon, I just wanted to double check if the following documentation is enough for 11750 (Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal): "Procedure: The patients left hallux was locally anesthetized with a 50/50 mixture of...
  9. K

    Wiki Total Talus Replacement

    Good morning, Is anyone familiar with the total talus replacement? I know it's going to have to be the unlisted code but I'm not sure which CPT(s) to use as the comparison CPTs. Thank you!
  10. K

    Wiki Mcbride and 1st TMT Arthrodesis

    The patient's preoperative diagnoses does include the hallux valgus, but the provider would usually start with the 1st TMT arthrodesis to treat the TMT joint degenerative disease and then notate that the hallux valgus was still an issue so the Mcbride was also done. He states that it's more work...
  11. K

    Wiki Mcbride and 1st TMT Arthrodesis

    Good morning! I have attached an op report pertaining to the 1st TMT arthrodesis using the Lapidus system and a Mcbride bunionectomy. I know there's 28297 which combines these two procedures, but I've also been told that this could be coded as 28740 and 28292 if the patient has degenerative...
  12. K

    Wiki E/M when Criteria not met?

    Ok, that definitely makes things simpler. Or as simple Podiatry could be haha. And just to make sure, this goes for commercial insurances too? Or at least the ones that follows Medicare guidelines?
  13. K

    Wiki DME Delivered at ASC/Outpatient Facility

    Hello! The CMS LCD pertaining to DME: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426) only mentions delivery at an inpatient facility. Does anyone know how to bill a DME that was delivered to an ambulatory surgical center/outpatient facility? We dispense the...
  14. K

    Wiki Celestone J0702 Injection

    Thank you so much!
  15. K

    Wiki E/M when Criteria not met?

    Got it! Thank you so much!
  16. K

    Wiki E/M when Criteria not met?

    If a patient comes in, but they don't meet the criteria to bill for routine foot care procedures (i.e. nail debridement, callus removal, etc.), can I still bill out an office E/M (i.e 99212) since the patient was still seen and examined and was educated on their diabetes status and what to look...
    • kle0204
    • Thread
    • criteria not met e/m routine foot care
    • Replies: 5
    • Forum: Podiatry
  17. K

    Wiki Celestone J0702 Injection

    Good Afternoon! For Celestone (Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg), how many mg is in one unit? I've been told it was 6 mg = 1 unit. I've seen past forums say 3 mg = 1 unit. And Codify has the bill unit as 5 (image below). Does anyone have an...
  18. K

    Wiki DME Medical Necessity Addendum

    Thank you so much!
  19. K

    Wiki DME Medical Necessity Addendum

    Patient was scheduled for surgery in the morning at an ambulatory surgical center. Provider realized that the patient did not have the correct knee brace so the clinic (we supply the DME, not the ASC) sent a referral to insurance and it was approved the same morning. Patient was discharged and...
  20. K

    Wiki Arthroscopic-Assisted vs. Conversion to Open (BEAR ACL)

    Thank you so much! I really appreciate it!
  21. K

    Wiki Arthroscopic-Assisted vs. Conversion to Open (BEAR ACL)

    Here is a copy of the procedure. I really appreciate your inputs! DESCRIPTION OF PROCEDURE: After informed consent was obtained, he was taken to the operating room and general anesthetic and adductor canal block administered. Left leg was examined under anesthesia, positive pivot shift...
  22. K

    Wiki Arthroscopic-Assisted vs. Conversion to Open (BEAR ACL)

    NCCI edits mentions that if a provider starts with a scope but it is then converted to an open procedure, then it would be coded as open. I have seen examples where the plan was to scope but due to complications or complexity, the scope had to be discontinued and an open procedure was performed...
    • kle0204
    • Thread
    • acl arthroscopic knee bear conversion to
    • Replies: 7
    • Forum: Orthopaedics
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