Medical Billing Forum

Coding => Coding => Topic started by: ninzadi on June 14, 2015, 11:46:24 AM

Title: Regarding Alabama Medicare Podiatry code
Post by: ninzadi on June 14, 2015, 11:46:24 AM
I am new to podiatry billing. I need some help for assisted living billing. Below you can see my billing info and just want to make sure it's right before they are send out for my company.

99325 with mod 25 for : ICD 9 443.9, 110.1,729.5,701.3
11721: with Mod Q9, 59 for :ICD 9 110.1, 729.5
11056: With Mod Q9 for 443.9 and 729.5 or 701.3

I am just confuse what modifier and ICD 9 code to use with. If this is correct the way I am billing then please let me know. This will be a great help for a new podiatry coder.  :'( :'( :'(
Title: Re: Regarding Alabama Medicare Podiatry code
Post by: kristin on June 14, 2015, 02:37:24 PM
1. The 99325 can only be billed if there was something else besides the nails and corns/callouses that was addressed, or there is enough of the E/M elements left to warrant a 99325 after you remove everything that has to do with the 11721 and 11056. Because there is an E/M portion already built into the 11721 and the 11056, billing an E/M also has to be really significant above the other work done. It doesn't matter that it is a new patient to the doctor, either. The OIG and Medicare is ALL over podiatrists billing out E/M's along with 11721's, etc, especially in NH's/ALF's. Huge audit red flag.

2. The 11721 needs to have the 59 modifier first, then the Q9 modifier second. You always put the modifier affecting payment BEFORE you put the informational modifier. The 110.1 is first, and the 729.5 second, so you have the right order of dx's.

3. The 11056: first, it gets billed before the 11721, because it has a higher RVU/fee schedule amount. Second, my MAC requires a 59 modifier on it also. Your MAC may not. If they do, then it goes before the Q9. Third, the 701.3 is NOT a covered diagnosis for a 11055-11057 CPT code. The 443.9 is, though, with the 729.5 second. So if the reason the patient had the 11056 done was the 701.3, you can't bill the 11056.
Title: Re: Regarding Alabama Medicare Podiatry code
Post by: ninzadi on June 14, 2015, 10:54:43 PM
Thanks a lot. So I see that on bill it was mentioned that patient has painful bunions and also has lower ext edema. Can they be incorporated for 99325?
Also billing for plantar fasciitis question in office setting for new patient for which a night splint was dispensed along with office xray and ankle strapping. Just want to make sure this has been billed correctly.

99203 with mod 25, icd 9 729.5, 728.71, 736.72, 734
 73600 with mod RT or LT, icd9 729.5
29540 with mod RT or LT, icd9 728.71, 729.5
L4396 with mod KX, LT or RT, ICD9 728.71, 729.5

Your input is the best help for me. Thank you so much and may god bless you😄😄😄
Title: Re: Regarding Alabama Medicare Podiatry code
Post by: kristin on June 15, 2015, 07:03:41 PM
Just because the bunions and edema were mentioned on the bill doesn't mean that they can be used as dx's for the E/M, it depends on what the doctor did for the patient regarding those two issues, if anything at all. You would need to query the doctor about that.

If you are coding for this doctor in addition to billing, then you need the treatment note in order to code the claim correctly. If you are just billing, then the doctor needs to assign the dx's to each CPT code, and you can add the appropriate modifiers, and put them in the right order on the claim, and put the CPT codes in the right order by RVU...but you can't dx for him, or decide if an E/M is warranted or not. That is his job, or a coder's job. You can certainly educate him on what warrants an E/M, what is considered medically necessary, what an LCD/NCD says, etc, but you can't code for him, if you are the biller.

As for the example of the patient with PF in the office, everything there looks fine, except that the 73600 is for two views of an ANKLE. If it was the FOOT that was actually x-rayed because of the PF, he assigned the wrong code. It should be 73620.

Also, if this is a patient who has standard Medicare as their primary, the L4396 has to go to DMERC, and not to Medicare for payment, and the doctor has to be contracted with DMERC.

My advice to all billers/coders who are new to podiatry is to immediately purchase the Optum Podiatry Coding Companion. It is invaluable.
Title: Re: Regarding Alabama Medicare Podiatry code
Post by: ninzadi on June 15, 2015, 07:53:15 PM
Thanks, so much. I'm going to order this book this weekend. Well doctor has assigned those code on E&M for me. He is also a new guy out of private practice from different medicare jurisdiction where he has never coded other than putting diagnosis code. I feel bad because he is trying hard and he is an intelligent guy but spending so much time doing charts and billing. I took all your advice and we are following what you have advised. Will it be ok if I can post few more questions regarding injection. Also in EMR when he put 17721 before 10056 , it's automatically putting nail care first. Should he consult the EMR company. I am just wishing he gets his money from insurance companies because he work so hard with patient even not charging the poolrs😪😪
Title: Re: Regarding Alabama Medicare Podiatry code
Post by: kristin on June 15, 2015, 09:40:34 PM
By all means, post whatever questions you have, and I will answer them. I have been billing podiatry exclusively for 20 years, there isn't much I haven't seen in that time. I understand your concern that he be reimbursed for what he does, and want to help with that. Just understand that while he may perform a service, that doesn't guarantee he will be paid for it. I see this all the time, with the podiatrists I bill for. It all depends on what each insurance company feels is medically necessary. Knowing the LCD's/NCD's/medical policy for each insurance company he is contracted with is very important.

As for the EMR listing the 11721 first...the EMR's I deal with let the doctor enter charges in any order they want to. It is up to to the biller in the PM side to order the charges correctly.