Author Topic: New Podiatry Biller  (Read 946 times)

winiawski98

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New Podiatry Biller
« on: November 07, 2016, 03:12:28 PM »
I have been billing for 20 years and I have my own home based company.. However, I have never billed Podiatry, Only family medicine and Pediatrics.  I need a lot of help.. I have getting denied on many things..  First of all I have received some denials from Medicare stating last date seen missing.. What does this mean? 

Also please tell me what is wrong with this example- Medicare denied it stating missing or invalid information
99213-25- L60.0 I73.9, R60.9, I77.9
11719-59,Q8- M79.674, M79.675, L60.2
11720-59, Q8 -B35.1, M79.674, M79.675

kristin

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Re: New Podiatry Biller
« Reply #1 on: November 07, 2016, 06:49:37 PM »
Hi there! I too have been billing for twenty years, and up until last year when I took on internal medicine, I had only billed podiatry. I run a podiatry office, and bill for several podiatrists remotely, also. So if you ever need questions answered, feel free to PM me, or ask them here on the boards. Over the years, I have helped several billers new to podiatry until they felt comfortable, and have lots of info prepared that I can send you. I even wrote a podiatry billing manual for a client once, and can send you sections of that if you want. To answer your questions:

1. Last Date Seen is the date that the patient last saw the doctor(cannot be the podiatrist) that is managing the systemic condition (diabetes, for example) the patient has that requires they get their nails or callouses debrided by a podiatrist. The date has to be within the last six months of DOS, and the managing doctor's name must be listed as the referring provider on the claim, as well as their NPI. The podiatrist's office has to provide you with all of that info, in order for you to bill the claim. The codes that require this info are 11719-11721, and 11055-11057, if the podiatrist is dx'ing a systemic condition. If not, it is not required. The LCD for the MAC in the jurisdiction the podiatrist practices in will have a list of all dx's that require the LDS, referring doctor, etc. You have to have that LCD at the ready to reference, as it is like the Bible for podiatry when it comes to Medicare patients.

2. For the claim that denied, exactly what part of it denied? I can see right off the bat that the L60.2 is not a covered dx for the 11719, at least not with any LCD I deal with, but need clarification on exactly what lines denied.

Kristin

winiawski98

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Re: New Podiatry Biller
« Reply #2 on: November 08, 2016, 08:16:22 AM »
WOW! You are awesome.. This is exactly the kind of info that I was looking for and the internet just does not provide it..  I am very new to this site. Still learning how to navigate it.. I will figure out how to PM.. I apologize in advance if I become a pest..
The part of the claim that denied was the 99213-25

So my problem is bigger than I thought.. The podiatrist does everything herself, including front desk.I connect remotely to her EHR system and there is no info on the referring provider or last date seen  by the doctor.  Just to be sure, is it just those 4 codes that need referring provider and LDS?

Do you know if Medicare and Medicaid are the only ones who require  the referring provider and LDS?. I've been billing other and insurances with out and I've been getting paid for the most part,
 Does the systemic dx have to be in a certain position? Like first or second place..  I remember reading something like that..

 Do you ever put Q8 on the E& M code or is that just on the procedures?

When do you use modifier 50?  I tried using it with 11719 and 11720 and it was incorrect..  If you use modifier 50 do you still use RT and LT or is that redundant?

 I was informed that modifier 51 was  not recognized by Medicare and should not be used.. Does this go for other insurances as well?

I can't thank you enough..  I am a small home based business and single mom and new clients are far and few between.. I know if I bill her correctly, it could be profitable for me..



kristin

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Re: New Podiatry Biller
« Reply #3 on: November 08, 2016, 07:24:28 PM »
Hi! To answer your questions:

1. The 99213-25 denying...was the DOS before or after 10/1/2016? Because many of the dx codes used for the 99213 are unspecified, and that could be the problem. Other possibilities are Medicare requested notes, to see if the 99213-25 was warranted and did not receive the notes, or the patient is in a global period from something else, and they want a 24/25 combo on the 99213. I would really call Medicare to find out exactly what the problem is.

2. The codes that need a LDS (depending on the dx used) are:
11055   Trim skin lesion
11056   Trim skin lesions 2 to 4
11057   Trim skin lesions over 4
11719   Trim nail(s) any number
11720   Debride nail 1-5
11721   Debride nail 6 or more
G0127   Trim nail(s)

3. I have never personally seen another insurance other than Medicare/Medicaid, or Medicare/Medicaid Advantage plans require the LDS/ referring doctor name/NPI.

4. None of the MACs I bill for require the systemic condition code to be listed in first or second place. Your's may be different.

5. The Q modifiers never go on E/M codes, only on the codes I listed above in #2, and they are only used if a systemic condition is dx'ed that requires them.

6. You only use the 50 modifier when bilateral procedures are done at the same visit, and even then they are limited to codes that have an indicator of 1 in the MPFS bilateral surgery column. So the reason they don't work on codes like 11719 and 11720 is that those codes have in their description how many nails need to be cut/debrided, in order to bill the code. So if you put a 50 modifier on a 11721, since that code description reads "6 or more nails", you are saying that the doctor debrided 12 or more nails, and that is not physically possible. You also don't use a 50 modifier on any procedure that is done on skin, because skin has no laterality, it is one continuous organ, with no left or right side, if that make sense. You do not use LT/RT at the same time as a 50 mod, because it is redundant, as you say.

7. Correct, you never use modifier 51 with Medicare, as they add it on their end to do the multiple procedure discount. I never use modifier 51 with any insurance, and haven't for years. No insurance I deal with wants it, they do what Medicare does, and adds it on their end.

8. As for the doctor doing everything herself...never a good idea, but there isn't much you can do about that. Sounds like she may be new to practice? Otherwise, she would know to provide you with the LDS/doctor info that you need. You need to talk to her about this, and explain that there is no way she can even begin to get paid for those charges unless she gets that info from either the patient when they are seen(tough to do, because many patients simply don't recall the date they last saw their doctor for their diabetes, or whatever), or she has to physically call the other doctors office and get that info. That said, if she is newer to practice, she may also not know that just because a patient has a systemic condition, that if other criteria are met, she does not need to even dx the condition with one of the codes above. So many podiatrists do not know this. There are basically 3 ways of providing routine foot care to Medicare patients, that are covered by the LCD, and for some reason, many podiatrists think there is only one way.

Finally, you won't become a pest...I love sharing what I know with others new to podiatry, it is a pleasure to help. If you look at the tabs when you log in in the upper left, you will see one that says My Messages. That is where you get your PM's.  ;)

Kristin

winiawski98

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Re: New Podiatry Biller
« Reply #4 on: November 10, 2016, 10:26:04 AM »
Once again. You are awesome and really know your stuff.  Thank you so much Kristin

kristin

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Re: New Podiatry Biller
« Reply #5 on: November 10, 2016, 08:18:45 PM »
You are so welcome!