03/12/2024    

QUERIES (BILLING AND CODING)

Query: Denial of Flexor Tenotomies

 

We are having difficulty receiving payment for a surgery. Here is the scenario: a diabetic presented with chronic pressure ulcers due to hammertoes. Flexor tenotomies were performed under local anesthesia in the office. We billed the patient’s Blue Cross Medicare Advantage PPO (advance checking for authorization was done and no authorization was needed).

 

Codes billed:

28230-T8

28230-T5 

 

The payer denied charges stating, "denied for exceeds number/frequency approved/allowed". We called Blue Cross MA and asked what this meant and were told they do not allow that procedure to be performed twice in one day. We asked them to look at the modifiers. They said they see the modifiers on the claim and said we could appeal. We appealed with a copy of the operative report. They are still denying the claim. Any suggestions or advice for the next step?

 

Vince Marino, DPM, Novato, CA

Other messages in this thread:

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03/11/2024    

QUERIES (BILLING AND CODING)

Query: CPT 99213 for ICD-10 B35.1

 

I billed a CPT 99213 for ICD-10 B35.1 because it was an E/M for treatment with Penlac for a patient with no other qualifiers. This claim was denied for Medicare with the only DX billed as B35.1. I contacted Medicare and reviewed the rejection. It was denied because B35.1 is recognized with routine foot care. Attached is the document that was reviewed. The DX code B35.1 is associated with routine foot care and requires the debridement codes. I'm being told It cannot be billed with an E&M as the ONLY and/or PRIMARY diagnosis. Routine Foot Care starts on page 244. 

 

My billing office is telling me my argument is that this is a DX code and should be reimbursable by payers when billed with an E&M. What recourse do I have? 

 

PM News Subscriber

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02/02/2024    

QUERIES (BILLING AND CODING)

Query: How to Get Medicare to Reject Bill for Orthotics?

 

I am having a coding problem. I have a patient with Medicare and Tricare whom I made orthotics for. Tricare will pay but needs a rejection from Medicare first. I billed Medicare trying to get them to reject the orthotic code but they just ignore it. I tried using the -GY modifier and had the patient sign an ABN. What is the correct way to bill Medicare so they reject it in a way that would allow Tricare to pay?

 

PM News Subscriber (NY)

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01/08/2024    

QUERIES (BILLING AND CODING)

Query: Post-Op Debridement in the Office

 

If a podiatrist performs a TMA and does not indicate within the operative note that there will be staged debridement in the office, what should be documented in the office note to support a wound debridement in the global period? A lack of any documented reason for the debridement would be considered to be included in the global, in my opinion. Routine post-op debridement in the office without documentation of a complication is included in the global, correct?

 

PM News Subscriber

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01/05/2024    

QUERIES (BILLING AND CODING)

Query: RFC Coverage Post Kidney Transplant

 

My patient is a non-diabetic who had chronic kidney disease (stage 6) and his neuropathic feet had been receiving routine foot care (RFC). He had a successful kidney transplant restoring kidney function. He still has neuropathic feet. Is he still covered for RFC?

 

PM News Subscriber