Billing > Facility Billing

Billing for Podiatry 99213 with 11721

(1/4) > >>

djk:
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:
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?

djk:
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:
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:
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.

Navigation

[0] Message Index

[#] Next page