Claim

Description: For MEX 5, the patient must be seen at least twice: once at the time of diagnosis to document the pain scale, and a second time to assess any decrease in pain. In order to document the patient’s pain, you must use the standardized pain scale 1-10. This measure tracks pain levels from the first visit to the last. No specific treatment is required—any intervention that effectively reduces the patient's pain is acceptable, the hammer toe diagnosis must be a part of the claim. Treatments may include surgery, changes in shoe gear, padding, and debride corns.

Top 10 Edits in May 2025 Source of information, National Government Services, Inc. (NGS)

What is one to do when a patient wants a claim to be resubmitted after her deductible is met when the claim was originally submitted prior to the deductible being met?

“If a patient refuses to pay their bill due to a high deductible, is it possible to request the insurance company (i.e. Anthem) to delete the claim? That way, the patient will still be responsible for paying their deductible amount elsewhere.”

“I often provide wound care for hospice patients and append the GW modifier. However, I recently read that it would be hard to defend this as the wound(s) and wound process is likely related to the patient being deconditioned and malnourished due to their hospice qualifying condition. I am looking for clarification regarding this, should I stop performing wound care services to hospice patients?”