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91
Starting Your Own Medical Billing Business / Re: Back up plan
« Last post by jrp on April 23, 2018, 05:40:44 PM »
I like your biller back-up idea.  Count me in.
92
Selection of ulcer debridement codes are determined by three factors:
1. Method of debridement
2. Depth of debridement
3. Total square centimeters of area(s) debrided.

So if the doctor debrided 20 square centimeters of tissue down to the subcu level, using a scalpel, you would bill 11042, regardless of how many ulcers there were. If he did more than 20 sq. cm's at the subcu level, you would also bill the add-on code 11045(next 20 square cms or part thereof). The 11047 is the add-on code for debridement into bone, not subcu tissue.

Here are the codes/add-on codes:
11042/11045-Subcu tissue
11043/11046-Muscle
11044/11047-Bone

Things to remember:
1. 11042-11047 never get LT/RT modifiers
2. The add-on codes never get 59 modifiers or X-modifiers
3. If the total area debrided goes over 40 square centimeters, you use the add-on codes with the appropriate amount of units. Say 42 square centimeters were debrided, it would look like this:
11042-1 unit
11045-2 units

While it is rare a podiatrist will have that many square centimeters debrided, if their scope of practice in their state extends to legs and not just feet/ankles, it can happen.

Since you are new to podiatry billing, the two biggest pieces of advice I can give you are to thoroughly review your MAC's LCD's on Routine Foot Care, Wound Care, and anything else that relates to the feet, and to purchase the Optum Coding Companion for Podiatry. It is the bible for podiatry, and every podiatrist or podiatry biller/coder should have one.
93
Correction to my above post....I am now seeing that the add-on code for additional area over the first 20 sq cm is 11047 NOT 11045. I am also seeing that I think I know the answer to this already and that I should only be billing 11042 once unless the total area was over 20 sq cm. if someone just wants to confirm this for me that would be great. Thanks so much!
94
I am new to podiatry billing and my provider did a debridement on a patient and billed 11042 with a LT and RT for wound care. I saw somewhere else on this forum that LT and RT should not be used, but that post was rather old. Is this still the case? Do I add up the centimeters and bill the 11042 and then do the add on code 11045 if it goes over the allotted 20 for the 11042?

I am in TN and this is for Palmetto GBA since they recently moved it from Cahaba.

Any help is appreciated. Thank you in advance!
95
Coding / Breast Pumps
« Last post by isanino23 on April 20, 2018, 01:48:02 PM »
Hello, 

Does anyone have experience with breast pump DME billing/coding?

Thanks,
Ivana
96
Coding / Re: billing 2 body parts on the same day
« Last post by PMRNC on April 18, 2018, 02:06:13 PM »
Quote
If it is the NP, I could give you some advise. However, an expert consultancy is still mandatory. Here how it goes. If you are visiting for NP for two different reasons and that too, on the same day; Modifier 25 could be your best shot. You will be asked for NOPs that falls in the same tax ID. Hope this helps.


HUH?  She said PT not NP. Michele had the better advise based on this specialty. I'd just ask that it's best to "inconvenience" the patient once you tell them their insurance may  not cover both on the same day, better to be inconveninced with time rather than a large bill :)
97
Coding / Re: billing 2 body parts on the same day
« Last post by BikhamHCare on April 17, 2018, 03:13:29 PM »
If it is the NP, I could give you some advise. However, an expert consultancy is still mandatory. Here how it goes. If you are visiting for NP for two different reasons and that too, on the same day; Modifier 25 could be your best shot. You will be asked for NOPs that falls in the same tax ID. Hope this helps.
98
Coding / Re: Medicare Reimbursement for 64555-SG, Surgical procedure
« Last post by BikhamHCare on April 17, 2018, 03:11:32 PM »
What it seems to me, the claim is meant to be processed by your Insurance Company. Even though, standard charges for the procedure fluctuates from State to State – it is advised to better consult your Insurance provider. In majority of the cases received charges are listed along with, “what can be paid and what is to be denied”. Google doesn't seem to help much in providing the prominent solution to your query, it would be advised if you could go look for an offline expert advise for 64555-SG.
99
Billing / Re: Is this legal?
« Last post by Christy on April 17, 2018, 01:01:43 PM »
I appreciate your in SIGHT  (ha ha), Linda!  ;D
100
Billing / Re: Is this legal?
« Last post by PMRNC on April 16, 2018, 12:33:58 PM »
MY personal knowledge of eye care is only from procesing claims and having been to eye doctors and have separate vision plan myself.

Where I go they don't routinely do the pressure test unless you schecule for it and unless there is suspect for certain conditions like glaucuma. When I schedule my visit they always ask me first. My own plan will pick up the IOP for suspect either on day or another day. So no, I don't think the doc is doing anything wrong UNLESs he's not using the proper E/M and of course the patient's benefits and coverage should be taken into consideration.
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