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09/11/2020    

CODINGLINE CORNER



Query: Waived Co-Pays for United Healthcare Medicare Advantage Plans


 


United Healthcare has very generously instituted a policy of waived co-pays for patients with Medicare Advantage plans. I wrongly presumed United would reimburse doctors with an increased allowed reimbursement to compensate. I did not receive any written notice and was only just advised by a telephone call from a patient/insurance clerk conference call requesting a refund for the patient. I must now refund a significant number of co-pays. This policy will be in effect till the end of October. United Healthcare pays poorly as it is. I have advised my staff not to appoint non-emergent United Healthcare patients until then. Any further thoughts or advice would be appreciated.


 


PM News Subscriber


 


Response: Based on this information from UHC’s website, unless you are testing for COVID-19, or treating COVID-19 conditions, and using diagnosis U07.1, cost sharing is NOT waived. This is why I always question information from a customer service representative, especially if the information is contrary to what I believe to be factual. I recommend calling a provider service representative and confirming or dispelling the information you had previously received. You might also consider speaking with a supervisor and ask for reference to their policy on cost sharing waivers during the COVID pandemic. DO NOT issue any refunds until you confirm your obligation based on written policy.


 


Ed Prikaszczikow, DPM, Council Bluffs, IA



 


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Other messages in this thread:


09/29/2020    

CODINGLINE CORNER



Query: Alcohol Injection Coding


 


I administered several alcohol shots in October and have received rejections. I have been getting rejections using CPT 64632. Can I resubmit a different code since they no longer pay for the alcohol injection? Perhaps a peripheral nerve block?


 


Benedict Valentine, DPM, Marlborough, CT


 


Response: The injection options for neuroma are:


1) CPT 64455-Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g. Morton’s neuroma)


2) CPT 64632-Destruction by neurolytic agent; plantar common digital nerve


 


What concentration of alcohol did you use? If you used less than 30% alcohol, that is considered not destruction but prolotherapy. CPT 64455 would be correct if you injected anesthetic by itself and/or steroid into a plantar common digital nerve-neuroma using one of the following diagnoses:


G57.61 Lesion of plantar nerve, right lower limb


G57.62 Lesion of plantar nerve, left lower limb


G57.63 Lesion of plantar nerve, bilateral lower limbs


 


If you provide CPT 64632 and as it turns out billed a non-covered service, then you can’t bill another code - only what you billed CPT 64632, then either the patient is responsible or you are based on your contract with the insurance carrier that is not covering the procedure.


 


David J. Freedman, DPM, CPC, Silver Spring, MD



 


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09/24/2020    

CODINGLINE CORNER



Query: The New CPT 99072


 


CPT 99072 (Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease). Here are some questions:


 


PM News Subscriber


 


Response: 


 


Q: Do you know what documentation is needed to support use of this code? I imagine we just have to chart “this visit occurred during a Public Health Emergency (PHE) – COVID-19”.


A: No, that is not good enough. This code accounts for extra supplies or additional staff time spent as a result of keeping you, your staff, and the patient safe during the COVID-19 PHE. Just like any other service we perform, you have to document what was performed. I suggest documenting that this visit occurred during the COVID-19 PHE and what extra supplies and extra staff time were devoted to this patient and this visit as a result of the COVID-19 PHE.


 


Q: Can we go back and bill this for all of the patients we saw since the pandemic occurred? A: No


 


Q: If not, what is the start date? A: September 8, 2020


 


Q: And finally – do you know how much this pays?


A: There is no value associated with this code but requests have been submitted to assign value.


 


Q: Can we start using it now or wait until the fee schedule tool shows it?


A: Yes, start using it now. My hope is the more of these that are submitted, the more likely we are to see payment begin.


 


Jeffrey D Lehrman, DPM, CPC, Fort Collins, CO



 


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09/23/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Elliot Udell, DPM


 


Thankfully, the lesion described was removed in time. This, however, does not mean that we should not be using dermascopes to examine suspicious lesions. In studies done, podiatrists who use dermascopes do more biopsies than those who visually examine lesions and ask if the lesions have undergone changes over time.


 


In my practice, I have saved the lives of two people by using a dermascope. In both cases, the patients were told by other doctors, one being a dermatologist, to wait and watch the respective lesions. My use of the dermascope enabled me to document the suspicious aspects of both lesions and arrange for surgical removal of both lesions, which both turned out to be melanomas.


 


Elliot Udell, DPM, Hicksville, NY

09/22/2020    

CODINGLINE CORNER



Query: Telemedicine for Hospitalized Patients


 


If a patient is hospitalized, can their podiatrist perform a telemedicine visit if they are not credentialed or on the medical staff? My guess is yes if the place of service billed is 11 with a modifier. Do hospitals have a right to prevent this telemedicine care from being provided by outside podiatrists licensed but not credentialed by a hospital?


 


PM News Subscriber


 


Response: If I understand this scenario correctly, a patient picks up their phone and calls/skypes you and has a question about their foot. I don’t see a problem with that. A hospital can’t “prevent” this from happening.


 


The next question, however, is what are you going to do for this patient? You can’t say soak your foot, take an ibuprofen, use an ACE, etc. If you have no staff privileges, you can’t order anything. I suppose you can call the admitting doctor or consulting podiatrist and voice your opinions, concerns, treatment suggestions, etc. 1) It would set up an awkward situation between the doctors,  2) you have no access to diagnostic data from the hospital to really understand the problem at hand anyway, and 3) other doctors discussing this with you would be a HIPAA violation without proper patient authorization. Again, what the patient tells you and what the actual situation may be could be very different.


 


Since the patient is designated an inpatient between dates X and Y, it might confuse the computer getting an “office visit” charge and might end up with a denial. With the COVID policies in place right now, you may get paid or not.



 


Tony Poggio, DPM, Alameda, CA


 


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09/22/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Bryan C. Markinson, DPM


 


I thank Dr. Boudreau for his kind reflections about me in his post detailing his fortunate personal experience with a lesion that turned out to be a curable stage of melanoma. The nonchalance (perhaps inaccuracy of diagnosis) of his internist and the quick action of his dermatologist actually support my assertions that improved clinical skills are critical in the non-dermatologist community, which includes podiatrists, internists, family practitioners, etc. In addition, I have been involved with a more than casual amount of delayed diagnoses and misdiagnoses by dermatologists as well. To another degree, pathologists are also capable of misdiagnosis. It would be wrong to interpret my position as trying to decrease enthusiasm, necessity, or performance of biopsies. I am on the record for years as holding the position that any podiatrist’s hesitancy to biopsy is fraught with problems, especially since the procedure should fall within everyone’s skill set.


 


However, putting everything "in a jar," (especially so stating in a public forum) to avoid responsibility for responsible differential diagnosis and achieve pseudo-comfort that a medico-legal standard has been satisfied is not the answer. Becoming better clinicians definitely is. This enables all of us to increasingly engage in discussion with pathologists when results are unexpected, and avoid unnecessary alarm to our patients, among other benefits.


 


It is still my opinion and experience that in a typical week, podiatry patients present with enough pathology that merits biopsy examination on nothing more than firm clinical grounds and pertinent personal and family history.


 


Bryan C. Markinson, DPM, NY, NY

09/22/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From:  Allen Jacobs, DPM


 


Given the apparent financial disincentive for skin biopsies demonstrating benign pathology, it would appear to be appropriate to INCREASE remuneration for correctly obtaining a biopsy of a malignant lesion. After all, early identification and subsequent local excision potentially saves the insurance carrier (forget the patient as insurance carriers do) significant costs for staging and treatment.


 


As for dermoscopy or confocal examination, I can hear it now: "Doctor, would a biopsy have correctly identified this lesion as an amelanotic melanoma?” "Doctor,  if this malignancy were identified earlier, could the metastasis have been prevented?” "Doctor, exactly how much training have you actually had in dermoscopy?” "Doctor, what would have prevented you from referring this patient to a dermatologist?” "Doctor, isn’t it true that you failed to perform a biopsy because you were concerned that the insurance carrier would not pay you?”


 


There is a responsibility which accompanies the decision not to perform a biopsy, the ultimate gold standard. The ethical obligation includes the acquisition of appropriate knowledge, skills, and experience to determine when or when not to biopsy. Insurance carriers do not determine the “standard of care.” Insurance carriers tell you what they PAY FOR, not how you should proceed in any particular case. As for dermoscopy, confocal microscopy, or just plain-old history and physical examination, statistical protection (probably not) is not absolute protection (definitive diagnosis) for the patient.


 


Allen Jacobs, DPM, St. Louis, MO

09/21/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 2



From: Robert Boudreau, DPM


 


During my 36 years of practice, I've noticed that when you get 10 doctors in a room together, you'll get 10 different opinions. While I respect Dr. Markinson as one of the leading experts in the field of podiatric dermatology, I respectfully disagree with his opinion.


 


Several years ago while visiting the beach, my daughter noticed a suspicious lesion on my shoulder, out of my visual field. She took a picture of it, and yes, it looked suspicious (asymmetry, different color shades). After returning home, I had my internist look at it and expected a dermatology referral, but to my dismay, he said, "Well, I dont think it looks that bad, let's just watch it for a while". Immediately after leaving his office, I called the dermatologist across the street, went in the next day, and guess what? She BIOPSIED IT. She didn't recommend dermoscopy, or confocal microscopy, she cut it out. Several days later, the pathology report returned as malignant melanoma, Stage 0. The next week, a hunk of my shoulder was in a jar, never to hurt me again. Had I "watched it", there is a high possibility that I might not be typing this tonight.


 


Bottom line, the gold standard for questionable lesions is still biopsy. Not only does it satisfy the medico-legal standard, it might just save someone's life. As my mentor said, "It can’t hurt you if it's in a jar."


 


Robert Boudreau, DPM, Tyler, TX

09/18/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 2



From: Bryan C. Markinson, DPM


 


Dr. Poggio queried, “What is the medical necessity of removing a benign lesion beyond the fact that it is there?” Dr. Boudreau responded, "In my residency 35 years ago, I was privileged to follow an “old school” dermatologist in his clinic one day per month. He biopsied EVERYTHING a patient was concerned about. I asked him why he did that, and his response was brilliant and I incorporated it into my practice. His answer: 1. You never know 100% what a lesion/mass is until you cut it out and look at it under a microscope, and 2. It can’t hurt you if it’s in a jar. This, Dr. Poggio, is why you remove a lesion."


 


First, I am a complete advocate for podiatrists doing more biopsies. However, although I can appreciate Dr. Boudreau's enthusiasm and intent on protecting his patients, his old school mentor's advice and his following it to this day, to say the least, is no longer appropriate in any way. Although this practice was commonplace...


 


Editor's note: Dr. Markinson's extended-length letter can be read here.

09/18/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1



From: Jeffrey Kass, DPM


 


“CMS decided several months ago that any callus distal to the DIPJ is 'contiguous' with the nail and therefore included as part of the nail care.” - Tony Poggio, DPM


 


This is something that has been discussed a couple of times now. This is clearly illogical and just plain dumb. I was wondering if the APMA can share with readership if this is something they deal with and if they have dealt with it. 


 


Jeffrey Kass, DPM, Forest Hills, NY

09/17/2020    

CODINGLINE CORNER



Query: RFC Denial Because of Location


 


Have you heard of any local carrier denying payment for CPT 11055, CPT 11056 or CPT 11057 based on location? I received a denial when the procedure was performed distal to the distal interphalangeal joint. I used the diagnosis code L84. Any thoughts?


 


Todd J Zang, DPM, Las Vegas, NV


 


Response: This denial should only apply if you also billed a nail care code at the same encounter. CMS decided several months ago that any callus distal to the DIPJ is “contiguous” with the nail and therefore included as part of the nail care. So, clearly document where the callus is. If all you billed was callus care, then this denial should not have happened.


 


That said, did they ask for chart notes? Did they say how they made the determination of callus location without chart notes? As one of the Noridian CAC reps, we are working on the RFC policy and want to make sure there are no glitches in the way the software is set up.



 


Tony Poggio, DPM, Alameda, CA


 


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09/15/2020    

CODINGLINE CORNER



Query: Impossible Injection


 


I am having trouble billing/getting paid by Anthem Blue Cross for a dexamethasone phosphate injection. I have tried several ways to bill the NDC number, but I always get a denial saying it is missing, invalid, or termed. Further, because of that “error” they do not pay any other lines of service for the same DOS. Other insurances do not deny me. The NDC# on the bottle is 55150-239-30 for dexamethasone sodium phosphate injection, 120 mg per 30 mL (4mg/mL). I have researched many websites for help. The last time I billed, the NDC info was placed on the supplemental line for J1100 as N455150023930 ML30 10 00. I normally inject 2 mL (8 mg) and charge for 1 DOU. What am I doing wrong?


 


Hratch Demirjian, DPM, Covina, CA


 


Response: The only thing I can see about the information you placed on a claim about the dexamathasone might be the format of the NDC number. The format is xxxxx-xxxx-xx. There are 5 digits in the first section, 4 in the second section, and 2 in the last section. If there isn't that amount on the bottle, you should place zeros before the number to make it match the 5-4-2 format. Try that and see if it works. If you are still having an issue, I would remove the injectable and bill the claim without it.


 


Alan Bass, DPM, CPC, Manalapan, NJ



 


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09/15/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: John Moglia, DPM


 


According to the UnitedHealthcare website, waived co-pays must be refunded to patients. It seems unfair and perhaps illegal not to compensate doctors for unilateral decisions in policy. I will raise my fee for providing patient records for chart reviews in response. Any lawyers out there for a class action suit? LOL.


 


John Moglia, DPM, Berkeley Hts, NJ

09/14/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Jessica M. Wade, MHA


 


Just to clarify for Dr. Prikaszczikow and others, the UHC co-pay waiver info is listed clearly on the UHC website as follows: "Members will have a $0 copay for covered primary care provider (PCP) and specialist physician services, as well as other covered services (listed below) between May 11, 2020 until September 30, 2020. By lowering our PCP and specialist copays to $0, along with our telehealth cost-share waiver, we hope to help make it easier for you to access care." 


 


The following services, if covered by your plan, are eligible for a $0 co-pay under the cost-share waiver, but do not include diagnostic tests and certain...


 


Editor's Note: Ms. Wade's extended-length letter can be read here. 

09/09/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Robert Boudreau, DPM


 


Dr. Poggio queried, “What is the medical necessity of removing a benign lesion beyond the fact that it is there?”


 


In my residency 35 years ago, I was privileged to follow an “old school” dermatologist in his clinic one day per month. He biopsied EVERYTHING a patient was concerned about. I asked him why he did that, and his response was brilliant and I incorporated it into my practice. His answer:


1. You never know 100% what a lesion/mass is until you cut it out and look at it under a microscope, and 


2. It can’t hurt you if it’s in a jar. 


 


This, Dr. Poggio, is why you remove a lesion. 


 


Robert Boudreau, DPM, Tyler, TX

09/08/2020    

CODINGLINE CORNER



Query: CPT 11424 Denial


 


I had a patient present with a soft tissue mass on the plantar aspect of her foot. Radiographs were preformed and an MRI was ordered. The patient refused contrast dye, so the study was limited. Due to her pain and concern for the lump having an insidious onset, I recommended excision. The patient underwent surgery and I billed CPT 11424. My differential diagnoses included hemangioma, lymphangioma, and AV malformation. Pathology confirmed hemangioma. Medicare denied the surgery as not medically necessary. My pre-op note, MRI, pathology report, and op-report were all submitted on appeal. Medicare still denied. The pathology report confirmed the size of the mass excised to support the CPT. Why would they deny this as not medically necessary  and what can I do at this point to reverse their decision?


 


Summer Weary, DPM, Cookeville, TN


 


Response: I suggest checking your Medicare carrier’s LCD (if they have one) for benign lesions. The tricky part is you don’t know its benign until after the path report comes back. Regardless, documenting the size, MRI report, op report, etc. is important. The key is documenting that the lesion is causing pain impacting her life, the lesion is growing, it is putting pressure on other structures, etc. Otherwise, what is the medical necessity of removing a benign lesion beyond the fact that it is there?



 


Tony Poggio, DPM, Alameda, CA


 


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09/04/2020    

CODINGLINE CORNER



Query: Routine Foot Care and ABNs


 


Does the patient need to sign an ABN if foot care is not covered? An example would be a patient with adequate pedal pulses and no class findings. In the past, I have read that ABNs are not necessary because the service is never covered. I know if they have class findings, they are usually covered, but if the patient chooses to come early, do we need to have them sign an ABN?


 


Joseph Bisignaro, DPM, Vineland, NJ


 


Response: Technically, no they don’t. I made it a habit in my office to have at least one per year on file for those patients as a back-up, but for statutorily non-covered services, it is not necessary. It is vital to have your documentation verify the lack of coverage findings too. As you know, patients can be confused about their prior visits, and their friends may note they “are always covered; so I have them do at least one ABN.


 


Michael King, DPM, Nashville, TN



 


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09/02/2020    

CODINGLINE CORNER



Query: Unsuccessful Hardware Removal


 


I attempted to remove a screw under local anesthesia in the office setting that was placed during a bunion correction about 10 yrs ago. I was unsuccessful and the patient will need to undergo the procedure in the operating room. How would I bill this visit? It was a new patient to the office.


 


Drew Taft, DPM, Derry, NH


 


Response: Since this was a discontinued procedure based on unforeseen or extenuating circumstances, I would use the -53 modifier on the hardware removal code chosen to reflect the actual hardware removed e.g. CPT code 20680. From CMS (CGS MAC 2012)


 


“Submit CPT modifier -53 with surgical codes or medical diagnostic codes when the procedure is discontinued because of extenuating circumstances. This modifier is used to report services or procedure when the services or procedure is discontinued after anesthesia is administered to the patient.”


 


Joseph Borreggine, DPM, Port Charlotte, FL


 



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09/02/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1B



From: Kristin Happel


 


I think part of the problem is that the initial nursing facility codes of CPT 99304-99306 are only to be used by the MD who does the admission of the patient into the nursing facility. Podiatrists need to use the subsequent codes of CPT 99307-99310, regardless of whether the patient is new or established. The three MACs I bill nursing facility visits for will not allow/pay for a DPM to bill the initial codes.


 


Also, Dr. Bass suggested billing the 11721 with a -59 modifier in addition to the Q8 modifier. There is no need for a -59 modifier in this billing scenario, as there was only one procedure performed, the 11721. However, he is absolutely correct that the E/M code needs a -25 modifier. 


 


Kristin Happel, Office Manager, Lake Zurich Foot Clinic

09/02/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER) - PART 1A



From: Alan Bass, DPM


 



While I respect Dr. Barney’s response which I agree with, I believe that the original inquiry contained a Q8 modifier as part of the question. That is the reason I included it in my answer. And yes, there are other ways that CPT 11721 can be billed without the Q8 modifier. 


 


Alan Bass, DPM, CPC, Manalapan, NJ


09/01/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Neil Barney, DPM


 


With all due respect to Dr. Bass, I have been told by another well known national coder that the use of Q8 is not only unnecessary with CPT 11721 (or 11720) but inappropriate as the criteria has nothing to do with the necessary documentation for the said codes. Comments?


 


Neil Barney, DPM, Brewster, MA

08/31/2020    

CODINGLINE CORNER



Query: Nursing Home Billing


 


I’ve just recently started seeing a few nursing home patients and I’m new to the billing side of things. I recently billed an E/M 99304 and CPT 11721 (with a Q8 modifier) for nail debridement in a new patient. I was notified the E/M 99304 wasn’t allowed, citing contractual obligation -97 (“the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated”). Am I doing something wrong?


 


D.S., Claremont, CA


 


Response: Most likely it is the way you are billing and are missing modifiers. That is why the CPT 11721 was lumped into the E/M 99304.


 


I would bill it the following way (with the appropriate diagnoses attached)


E/M 99304   -25


CPT 11721  -Q8,-59


 


Alan Bass, DPM, CPC, Manalapan, NJ



 


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08/27/2020    

CODINGLINE CORNER



Query: Non-covered RFC after an Amputation


 


A patient of mine had right, below-the-knee amputation approximately two years ago. He comes to us for care of his left foot, including shoes and inserts, care of ulcers, debridement of dystrophic nails, trimming of calluses, etc. Medicare is now denying CPT 11720, saying that at-risk care of toenails is not covered for 5 years after an amputation. We explained that he still has one foot that is definitely at risk. They said it is a new rule. We did not find a specific LCD or any other information confirming this. So are we expected to provide free care? Charge the patient cash? Any insight into this would be appreciated.


 


Jeff Bean, DPM, Carson City, NV


 


Response: Your Medicare Administrative Contractor (MAC) in Nevada is Noridian. Noridian does not have any such rule that you described here. I suggest you ask whomever you communicated with to share the documentation that reflects this rule. It does not exist.


 


Jeffrey D Lehrman, DPM, CPC, Fort Collins, CO



 


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08/26/2020    

RESPONSES/COMMENTS (CODINGLINE CORNER)



From: Kristin Happel


 


First, the CPT 11423 should have been sent in on the claim as 11423-59-LT, and not as you listed it, which was 11423-LT-59. The modifier affecting payment (the 59) ALWAYS goes before the informational modifier (the LT). Second, the diagnosis of Q81.9 is most likely not a covered diagnosis for 11423, which is why you received the "not medically necessary" denial. When I look in the Podiatry Coding Companion, Q81.9 is not a covered diagnosis, so that backs up my theory. 11423 is for the excision of a benign lesion, with margins of 2.1 cm to 3.0 cm.


 


The diagnosis Q81.9 is for epidermolysis bullosa. I think that the insurance company is not considering a bullosa the same thing as a lesion. There is perhaps a more accurate CPT code you could have billed in the 17XXX range, or it could be that the insurance company considers this a cosmetic procedure, and not a medically necessary procedure. To prevent denials moving forward, I  suggest calling the insurance company and getting approval for all surgical codes/diagnoses to be used prior to surgery.


 


Kristin Happel, Office Manager for Dr. Elizabeth Sosinski

08/25/2020    

CODINGLINE CORNER



Query: Surgical Combination Issues


 


I am billing for a surgery with the procedure codes CPT 28291 -LT (Hallux rigidus correction) with the diagnosis M20.22 and the procedure code CPT 11423 -LT, -59 (Excision of Lesion 2.0-3.0) with the diagnosis code Q81.9 Epidermolysis bullosa. The CPT 11423 is being denied as “not medically necessary.” Is this a common denial? Should I appeal?


 


Gerald Newman, DPM, Conyers, GA


 


Response: The insurance company is assuming that both procedures were performed at the same site. If the CPT 11423 was at a different site on the foot or on a different foot, I would appeal with notes clarifying the sites. Usually that will work, but no promises.


 


Katherine Sharp, Keystone Professional Solutions, Woodbury, TN



 


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08/24/2020    

CODINGLINE CORNER



Query: Same or Similar Frustrations


 


Has anyone has ever had Medicare DME reverse a denial on a “same and similar” claim for any device? It seems unreasonable that if a patient once had a night splint and now one year later needs a walking boot for a new condition, that the boot will be denied. Unreal! Recently, I received denials on two different claims on the two different appeals and they are identical explanations for two different issues. It seems that patients need to be urged to hang on to any DME item for at least 5 years. Under any circumstance they should also last that long! Do we really need to have a separate department within our office to run DME dispensing queries on patients before they are seen?


 


PM News Subscriber


 


Response: It is imperative that somewhere in your examination note, documentation of what was previously dispensed and why it is inappropriate for the current diagnosis must be noted. In your scenario, as an example of what you may wish to consider including in your note: "The patient was dispensed an off-weight-bearing ankle splint (L4397) in January 2020 for a diagnosis of M722. They now have a fracture of a 2nd metatarsal of the left foot (S92.325A) necessitating a CAM Boot (L4397) which provides rigid immobilization on weight-bearing."


 


The fracture diagnosis is new, different, and unrelated to the previous January 2020 diagnosis. A metatarsal fracture cannot be treated with the previous L4397.


 


Paul Kesselman, DPM, Woodside, NY



 


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