Author Topic: Podiatry Care/EM code  (Read 1672 times)

djk

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Podiatry Care/EM code
« on: April 28, 2014, 08:00:55 AM »
Can you bill Medicare for a E/M visit (99213) along with a debridement of nails (11721)???
« Last Edit: April 28, 2014, 08:21:24 AM by djk »

Merry

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Re: Podiatry Care/EM code
« Reply #1 on: April 28, 2014, 10:00:27 AM »
My gut says no and of course the dx has to support the medical necessity such as diabetes.
Podiatric billers.. Weigh in please.

Merry

kristin

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Re: Podiatry Care/EM code
« Reply #2 on: April 28, 2014, 11:26:23 AM »
So long as the EM is significant and separately identifiable from the nail debridement, yes. If the EM was just to assess the nails and decide to do the debridement, no. That is built into the 11721 already.


djk

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Re: Podiatry Care/EM code
« Reply #3 on: April 29, 2014, 12:17:24 PM »
That is what i thought just want to check thanks for your help

jennifer8055

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Re: Podiatry Care/EM code
« Reply #4 on: April 29, 2014, 01:13:54 PM »
as long as the e/m is for something more than just the debridement (proven by the dr's office note) - you can bill e/m w/the 11721 and add a -25 modifier to the e/m code

dpetras

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Re: Podiatry Care/EM code
« Reply #5 on: December 08, 2016, 01:43:49 PM »
So I need help with this too.  I'm wondering, since the 11721 is "built into" the 99212, that means I just bill the 11721 alone?

kristin

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Re: Podiatry Care/EM code
« Reply #6 on: December 08, 2016, 10:25:38 PM »
I will repeat my answer from before in this thread...

"So long as the EM is significant and separately identifiable from the nail debridement, yes(it can be billed). If the EM was just to assess the nails and decide to do the debridement, no. That is built into the 11721 already."

Basically, the patient has to have a separate problem(s) in order to bill the E/M with the nail debridement, and the E/M level chosen has to meet 3/3 requirements for a new pt, and 2/3 requirements for an established patient. If you have that, you can bill the E/M, if not, you can't.