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Coding
Issues Billing “At Risk,” Routine Foot Care: Challenges Billing CPT 11057
“How are we supposed to bill CPT 11057 to Medicare to get paid? For the typical patient, we currently use the ICD-10-CM codes E11.42, E11.51, L84, R26.2. We bill this as its own claim. We put the podiatrist as the referring physician. We do not use any modifiers and we previously used the Q8 Modifier when appropriate, but it was denied. What does the proper 1500 form look like for CPT 11057?”
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Coding
Routine Foot Care: Response to Bundling
“Medicare sent me a letter about 6 months ago saying I bill CPT 11721 too often compared to CPT 11720 and CPT 11719. However, they consistently deny the combination of CPT 11719 and CPT 11720-59. Not just bundled, but deny both codes, altogether. That then leaves me an outlier with a bunch of CPT 11721 counted and all of the CPT 11719 and CPT 11720 denials left out of the calculations. Appeals are denied (and a waste of time and resources for $11). Their CCI indicator is 1, meaning they can be billed together with 59 or X- modifier on the column 2 code (CPT 11720). Is it fraudulent billing to code only CPT 11720 even though I am debriding 1 to 4 nails and trimming the rest? It also pays more with just CPT 11720 since it is otherwise secondary to a less-than-$11 CPT 11719 code. I hate to turn away these patients who have a true need. Recommendations?”
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HIPAA
Is it a Permitted or Required Disclosure?
HIPAA has specific rules of who you can share patient information with. Some disclosures are permitted only with patient consent, other disclosures are permitted without consent.
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FDA Recalls
MIPS
Promoting Interoperability: Attestations
For promoting interoperability, you have to attest to several items. There is ONC-ACB Surveillance Attestation, ONC Direct Review Attestation, Prevention of Information Blocking Attestation, Security Risk Analysis, and High Priority Practices Guide of the Safety Assurance Factors for EHR Resilience (SAFER Guides)
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HIPAA
Do No Harm
As a medical professional, the initial intention of ‘do no harm’ is treating your patients with the best possible care. However, in this era, our responsibility is that much greater.
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