Billing > Facility Billing

Billing 11721 with 11055 or 11056

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djk:
Yes, it is harder, LOL... I have tried to find on the NGS website the LCD codes for the 11055/11721 but no luck. There are some articles that touch on the subject but not completely.. I guess it's just trial and error..

kristin:
This is what you need:

http://www.ngsmedicare.com/ngs/portal/ngsmedicare/a45934/!ut/p/a1/tVLLkoIwEPwVPXi0MgJROaKLlA98QFkKFytCxKgExZS1_v0moLUe1sdlc0pnupNM96AQLVHIyYUlRLCMk4PCYXMFY_3L6mEDwMcY-jZ4LddvaWA0JCFQhIHfLQmuCdC3mn7PcUCfjLVS_3fZGBp3_ZNlwUv9BKMFClF4JhcaZdmeUYWiAyX5L_Rspz8ZFwUujmKLAp6cUxqziORSxQXlogYPZzWIsgvNSUIrMRU0Txkv7KhByThUjtmBRddKJJU0rwExsKkb6oWjFMX0zBJeoIjFKCA4Jq24DQamsoMmMbUGxIQ2N42Njs128cfRpIOCKclFpfPaUdXym0QKR95kUhKemx7IP7SePjLUkK_uWHTd1Wxue5L9kIBEjwlIeEtA7h77_NygwQdDqOVu101UAmJbZ3yToeUtFllku9MptOQAqLS_BVr-0wQsStvuxjvmqAf9mWs4dttsgC2HGdCCROqq0sHbPjgrv7bomM7ne89p7-gab_xpmlrWdFwP11cdB6lVrf4AkPGDlQ!!/dl5/d5/L3dHQSEvUUtRZy9nQSEh/?clearcookie=&savecookie=&REGION=&LOB=Part%20B

And a quick review shows that your dx of 701.1 is not covered...but you aren't getting a dx denial, which is odd.

djk:
This doctor only works in our clinic one day a week, so I called her office and they told me that they bill 701.1 and get paid for it, so that is why I placed this on the forum if any one else was having difficutly with this code..thanks for the attachments

Michele:
I think you are missing the appropriate Q modifier.  See this article:  http://c.ymcdn.com/sites/www.wocn.org/resource/dynamic/forums/20130225_124324_31289.pdf

I bill those codes to the NY MAC.  If they have a covered dx and the appropriate modifiers they are reimbursable.

The concern I have is that you cannot simply add modifiers or change coding to "get them paid".  It is important that the coding is done by someone who has access to the chart and is qualified to code.  Just want to make sure you aren't just coding for them to get the reimbursement.  The documentation in the chart must match the billing.

HeidiK:
Hello!

One issue to consider is how Medicare is able to identify medical necessity.  The coverage determinations state how debridement is only allowed as a separate service is if there is clinical evidence to support the need.  That simply means if they have never had a claim filed for a mold or yeast culture for the patient, the system will continue to reject the debridement no matter which diagnosis code is used.

The LCD I reviewed did not show 701.1 as an allowed diagnosis code for 11720 or 11721, but I wasn't sure by your last post if this was the code you referrred to in your last post.

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=27487&ContrId=161&ver=45&ContrVer=2&DocType=Active&bc=AgIAAAAAAAAAAA%3d%3d&

I went to cms.gov and searched "debridement of nails" and a number of links came up which may also help...

http://cms.gov/site-search/search-results.html?q=debridement%20of%20nails

I haven't done podiatry billing in some time however, I do remember needing to use the foot and toe modifiers (TA - T9) in order for claims to process correctly as well.

Hope this helps!

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