“What is the date that fracture care begins? Is it the date of the injury or is it the date of service when the doctor makes the decision for closed management of a fracture?”
“Outpatient surgery was performed at a surgical center. We billed Blue Cross for CPT 11750 (T5) and CPT 11730 x 3 (T2, T7, T9). But they only paid CPT 11750. And the denial reasons are: ARV – Quantity billed exceeds CMS medically unlikely edits (MUE) limit. Rebill within MUE limit if appropriate. 222 – Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: refer to the 835 healthcare policy identification segment, if present. So my question is, what is the limit to bill for ingrown nail surgery?”
“I think it is time for this topic to resurface. Being a coder/biller for a number of podiatrists around the U.S., I am finding that some are still scheduling “annual diabetic foot exams” as a routine on all of their diabetic patients. They are then performing a “full physical exam” and trying to bill an E/M. Sometimes this coincides with callus or nail treatment, at which time they want to add the 25 modifier. Of course, I am telling them that Medicare does not pay for an “annual diabetic foot exam” and that it is not a benefit and as such should be CASH. Has anything changed?”
