Author Topic: Billing for Podiatry 99213 with 11721  (Read 4719 times)

djk

  • Newbie
  • *
  • Posts: 43
Billing for Podiatry 99213 with 11721
« on: June 05, 2014, 07:13:57 AM »
I bill for Upstate NY Medicare, for a new Podiatry provider in our clinic.  He is billing for 99213 with the procedure code 11721.  I place the 25 modifer on the E/M code and sometimes Medicare pays for this and sometimes they dont.  Any thoughts on this from you seasoned Podiatry billers.

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4761
    • Solutions Medical Billing
Re: Billing for Podiatry 99213 with 11721
« Reply #1 on: June 05, 2014, 08:43:17 AM »
It's hard to say without the specifics.  I have a couple thoughts but without knowing more info I have no idea which one it could be.  Can you give an example?
Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com

djk

  • Newbie
  • *
  • Posts: 43
Re: Billing for Podiatry 99213 with 11721
« Reply #2 on: June 05, 2014, 10:55:35 AM »
billing for a debridement of nails, 99213  dx 110.1,729.5 and 443.9 with mod 25, 11721 with 110.1, 729.5,443.9 with Q8 mod and 59.

Merry

  • Sr. Member
  • ****
  • Posts: 363
Re: Billing for Podiatry 99213 with 11721
« Reply #3 on: June 05, 2014, 03:11:44 PM »
Medicare only covers for Debridement with certain diagnosis codes such as diabetes,  neuropathy etc.  Could that be the issue? I did not look up the codes that you used.

kristin

  • Sr. Member
  • ****
  • Posts: 492
Re: Billing for Podiatry 99213 with 11721
« Reply #4 on: June 05, 2014, 07:38:15 PM »
So are you saying the claims looks like this:

99213-25  110.1;443.9,729.5
11721-Q8-59 110.1.443.9,729.5

and that the 99213-25 is denying sometimes and not other times? I am surprised it is paying at all, because the 11721 has an E/M element built into it already, and using the same diagnoses for the 99213 is going to cause denials. I am not saying to change the diagnoses to get the claim paid, mind you, but short of sending in notes to prove that the 99213 was significant/separate from the 11721, you probably won't get paid separately for it. The only time the podiatrists I bill for use a 99213 with a 11721 is if they addressed issues above and beyond the issues resulting in the need for the nails to be debrided. I also don't know why you have a 59 modifier on the 11721 when it is the only procedure being billed.

djk

  • Newbie
  • *
  • Posts: 43
Re: Billing for Podiatry 99213 with 11721
« Reply #5 on: June 09, 2014, 06:45:11 AM »
Thank you and the 59 modifer I only post that when i bill the 11721 and a 11055(11056) my mistake sorry.. I thought that you couldnt bill the 99213 with the 11721 but thought i would ask..

Medicare does cover debridement for nails if not diabetic as long as you can use the diagnosis for pain 729.5 and 110.1. just an FYI thanks to all for your input..

kristin

  • Sr. Member
  • ****
  • Posts: 492
Re: Billing for Podiatry 99213 with 11721
« Reply #6 on: June 09, 2014, 06:47:12 PM »
Yes, most MAC's will cover the 11721 with just the 110.1 and 729.5 dx, if it fits the patient's particular need for the debridement.

You CAN bill the 99213 with the 11721...but it truly needs to be above and beyond the 11721 elements. I think in your case, because the provider is using the same dx's for both, it just won't cut it.