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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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    Wiki Podiatry

    Adam, orthocoderpgu said in a post from September that the power point is no longer available. I see you are in CA as am I. I have a one hour course/presentation available for all jurisdictions for routine foot care and another for wound care, PM me if interested.
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    Wiki URGENT! NEED CPT FOR TALONAVICULAR CHEILECTOMY

    Need more information.
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    Wiki Post Op Wound

    Unfortunately the provider usually gets dinged for the unreliable patient. If the patient has to be brought back to surgery the 78 modifier can be used. The 79 modifier indicates the condition is unrelated to the procedure for which the 90 day global applies, so that does not work either...
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    Wiki BONE MARROW HARVEST

    The 38220 code is for diagnostic purposes. Since the other codes you have chosen do not include the words "includes obtaining graft", 20900 would be the appropriate code as the aspirate was small. 20902 is for a large harvest.
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    Wiki Tailor's Bunion 5th Toe (Reverse Austin)

    It looks like a true osteotomy was performed on a tailor's bunion, 28308, osteotomy, lesser metatarsal would be appropriate. If a complete resection of the 5th met head was performed then 28113 would be more appropriate, however, that is not what is documented.
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    Wiki 11750 Documentation

    Most payers including Medicare add the 51 modifier as a system edit. It generally does not affect the claim. (There are some Medicaid exceptions) While 11750 can be billed bilaterally, the 50 modifier does not apply as the T modifier is required for payment and so should be coded on separate...
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    Wiki Slant back

    I mean no disrespect, 11765 is not the code to use for a slant back. The wedge excision is performed on skin, not nail and involves the surgical removal of a section of tissue that is thick at one end and tapers to a thin edge. This skin is often associated with an ingrown nail, however, in my...
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    Wiki Slant back

    This is a hot topic. 11719 is defined as trimming of non dystrophic nail in length. A slant back is not trimming of length. It is a procedure used to relieve a mild ingrown nail. To my knowledge there is no code for this procedure. If the documentation, medical decision making, is...
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    Wiki Diabetic Footcare Documentation

    I hope I am understanding your question correctly. When performing callus and/or nail treatment on a diabetic or other patients with and asterisked diagnosis as per your local LCD, that patient must have the name of the doctor treating the diabetes or other condition and the approximate date...
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    Wiki 27620 & 27695

    Removal of the fragments is included in the 29892 code. Thus I would code the 29892 and 27695
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    Wiki EPF w/heel spur resection 29893 & 29999

    Code only the 29893. The exostectomy is included.
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    Wiki Billing 28112

    51 modifiers are payer system generated...there are very few that require the coder to add the 59.
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    Wiki Billing 28112

    With most payers, the 51 modifier is a system generated one at payer level. Only a handful of Medicaid plans want the 51 added. In this posted scenario, the RT or LT modifier along with the XS or 59 modifier on lines 2,3,4 would be the most appropriate.
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    Wiki Billing 28112

    Metatarsal bones are not toes. Thus the T modifiers are not correct. With that said...Anthem wants T modifiers.
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    Wiki Unna Boot documentation

    29580 falls under the "strapping" category. Unna Boot is a product that has no stretch and has a layer of zinc which many believe assists in the healing process, it is usually followed with coban or ace wrap due to the sticky nature. It is not a multilayer compression wrap. If the doctor...
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    Wiki Mcbride and 1st TMT Arthrodesis

    What was the intent of the procedure? To correct a bunion? 28297 seems like the correct code. Otherwise its unbundling.
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    Wiki Tarsometatarsal Joint - Intermediate or Small?

    The majority consensus in Podiatry is that the joints between the tarsal bones: ankle, talocalcaneonavicular, cuneonavicular, cuboideonavicular, subtalar, talo-navicular, intercuneiform and calcaneocuboid joints (I may have repeated joints) are all intermediate, any joints distal to those would...
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    Wiki NCCI MUE Edit Denials

    The location where the service is rendered can affect what is billable. Hospitals can charge for a tissue to blow your nose...exaggerating! In general, any syringe used to complete a procedure is included in the CPT for the procedure. Coding for catheter placement is not my specialty.
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    Wiki E/M when Criteria not met?

    ABN is only for Medicare. Medicare advantage plans should follow the same coverage guidelines.
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    Wiki wound vac reapplication during the global period

    97605-97608 can be coded and billed during the global period of a surgery. Code according to size of wound.
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    Wiki podiatry - I'm new to podiatry

    Email me for more information. toniasilva856@gmail.com
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    Wiki NCCI MUE Edit Denials

    Example 1. The thigh high overruled the knee high since it goes past the knee. Can't wear both. Example 2. If an injection was performed then all syringes etc are included in the payment for injection.
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    Wiki DME denials - Please help

    My pleasure!!
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    Wiki IS 11750 always once per lifetime per patient ?

    You can now code a repeat 11750 with a KX modifier indicating that there is documentation supporting the repeat procedure. Be sure the documentation clearly states why the procedure needed to be repeated. If 11750 was performed, do not code another procedure just to get paid, that is fraud.
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    Wiki E/M when Criteria not met?

    If a patient comes in for foot care that is routine in nature and does not meet the requirements for coverage, an ABN is not needed as it is statitorily not covered. You are not required to send a claim for the service, it would be CASH pay. To code an E/M in the place of a non covered service...
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    Wiki Podiatry EMR

    We are using NextGen Office. It is not podiatry specific, per se, however, the APMA backs it and is actively promoting and providing templates etc. I offer support on this platform if you decide to go that direction.
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    Wiki Custom Orthotic Coding Assistance

    Some payers prefer that code over the 29799.
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    Wiki Arthrodesis 4th metatarsophalangeal joint?

    My pleasure!
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    Wiki HELP PLEASE!

    Correction of the hallux valgus is 28292. Tailors bunionectomy is 28308. Now, the "cheilectomy"...there is no cpt code for a cheilectomy of the lesser metatarsals. The procedure states there was "spurring" which was "resected". If this was a partial resection, 28122 would be appropriate...
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    Wiki podiatry - I'm new to podiatry

    I offer private coding courses. toniasilva856@gmail.com
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    Wiki Arthrodesis 4th metatarsophalangeal joint?

    Heather, while the diagnosis is helpful, it, by itself does not answer your question. A fusion of a joint is an arthrodesis. There is a cpt code for arthrodesis of the 1st mtpj but not of the lesser toes. The code 28285 is for the correction of the phalages only, no work involving the...
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    Wiki DME denials - Please help

    Medicare nor Medicare Advantage plans cover custom orthotics, this is likely why you are getting denials. The LCD you mention states that an orthotic is covered when attached to a covered brace...which rarely if ever is the case. In addition, many commercial payers do not cover them either...
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    Wiki Separate Procedures

    Same incision, separate incision...does not matter from a coding standpoint if they are procedures performed to treat different conditions. Don't get confused with bundling and separate procedures. There are many codes that have a combination of procedure codes bundled into one code...
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    Wiki PEDORTHIST

    99211 is defined as "evaluation and management of an established patient". The code levels are now based on "medical decision making" however, this low level code has no MDM assigned to it. As with all services billed to Medicare or a MAP, procedure code 99211 services must be reasonable and...
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    Wiki Can an RN perform/bill CPT 97597?

    While the CMS coverage database article is poorly written, or clear as mud as I like to put it, it states: "For hospital patients and for SNF patients who are in a Medicare covered stay, there is no Medicare Part B coverage of the services of physician-employed auxiliary personnel as services...
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