Billing

“So, to be clear you can never use L3000kx for a diabetic with neuropathy and diabetic ulcers even if secondary will pay.”

“Medicare pays approximately $40 more for E/M code 99213 versus an injection for a neuroma. Can you give the injection and only bill the E/M 99213?”

“I am wondering if any other podiatry practices are having issues with Aetna Medicare getting paid for CPT 11730? The denial of the claims focusses on “LCD guidelines.” We are sending numerous appeals along with medical documentation and the actual article from Medicare (L34887).”

“In many cases requiring an arthroplasty of the proximal interphalangeal joint (PIPJ) 5th digit (especially when associated with a heloma molle), I often do an arthroplasty PIPJ, flexor lengthening and a partial syndactylization (advancing the webspace but differently than the description of Ruiz-Mora). I have always simply billed for an arthroplasty PIPJ 5th toe. Now I have been forced to pay attention to coding because of my EMR program. Should I have been billing this differently for all these years?”

If you haven’t done so already, employ the help of your biller, billing company or a seasoned administrative staff member to clean up both insurance and patient aging. Start with insurance aging to ensure patient balances are correct before attempting to collect one last time this year.

“Can you describe what is a “sufficiently detailed exam” to confirm the diagnosis of peripheral arterial disease? I was audited and the debridement of calluses were denied even documentation of every single class finding were listed. Are we supposed to do ankle brachial indexes, Buerger’s test, etc.? Why have class findings if they do not qualify as “sufficiently detailed?”

“I billed A5500 and A5512 with modifiers -KX, -RT, -LT. L1940 KXRTLT L2330 KXRTLT L2820 KXRTLT I billed these on separate lines. This claim was rejected so we re-billed putting the KX modifier in the 3rd spot and it was still rejected for the same reason. The comment was: 4 – the procedure code is inconsistent with the modifier used or a required modifier is missing Any thoughts on how to tackle this denial?”

If our provider does multiple Tenotomy procedures on one visit on different toes what are the appropriate procedure codes and modifiers to bill correctly? We have been billing 28010 with the "T" modifier and no other modifiers per the provider's request. I feel like we should be adding a "51" modifier on all lines except the first. I would love assistance with this.

In order to bill 28292, 28295, 28296, 28297, 28298, 28299, the medial aspect of the head of the 1st metatarsal MUST be excised/removed in addition to any additional procedures that are performed to correct the hallux valgus deformity to justify and support the CPT code that is billed.

“I order liver enzymes prior to prescribing an oral antifungal. The blood work is a part of the risk and complications to determine the level of E/M. Can I also include the prescribing of the oral antifungal as part of risk and complications since it is waiting for the lab results?”