nccodingchick
Networker
Is anyone else having trouble with billing the debridement codes for Palmetto NC claims?
Thanks!
Stephanie
Thanks!
Stephanie
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki 11056 Palmetto Claims
- Thread starter nccodingchick
- Start date
ANDREAHSANCHEZ
Guest
- Messages
- 25
- Best answers
- 0
CODES: 11055-11057
I read something on this stating medicare will only reimburse for this if it is medically necessary which usually means the dx must fall in the catigory of what they determine would be a dx in which this procedure would be covered. Which in reading sounds very limited. You must first have a dx of either 700, 701.1, or 757.39. Then you must have a second dx of either 686.9, or 729.5. On every claim which if this is the case and it is medically necessary the phys. Must document this so you can code properly. In this case if you want to get paid. Good luck.
I read something on this stating medicare will only reimburse for this if it is medically necessary which usually means the dx must fall in the catigory of what they determine would be a dx in which this procedure would be covered. Which in reading sounds very limited. You must first have a dx of either 700, 701.1, or 757.39. Then you must have a second dx of either 686.9, or 729.5. On every claim which if this is the case and it is medically necessary the phys. Must document this so you can code properly. In this case if you want to get paid. Good luck.
mitchellde
True Blue
This is covered only for certain diagnosis, Can you provide more on the documentation as well as the denial reason from Palmetto?
msr1984
Contributor
was that supposed to be mod-57 or mod-59??? if you are using 57, that is part of the problem. you didn't mention use of a Q-mod either, does your patient have a qualifying disease or disorder to warrant med nec??
mjb5019
Guru
Denials
Have you gone to the Palmetto website to check the local coverage determinations for the MN dx'es? From there you would go to check the NCCI edits to see if the procedures you are querying bundle, whether they can be unbundled, and then over to the MUE's to see how often they can be billed.
Have you gone to the Palmetto website to check the local coverage determinations for the MN dx'es? From there you would go to check the NCCI edits to see if the procedures you are querying bundle, whether they can be unbundled, and then over to the MUE's to see how often they can be billed.
Shay2025
Networker
I billed for a podiatry clinic for three years. Provided the patient had these dx's i would bill the following:
11056-11057 - 250.6x or any supporting dx with a Q7 Q8 or Q9 modifier. however Medicre does require the box 15 to be filled out when using the Q modifiers
11720-11721 - 110.1, 729.5
I was able to bill these together with a modifier -59. I never had trouble unless the provider did not dictate something and in that case as all coders know " if its not dictated it didnt happen"!!!
Hope that helps
11056-11057 - 250.6x or any supporting dx with a Q7 Q8 or Q9 modifier. however Medicre does require the box 15 to be filled out when using the Q modifiers
11720-11721 - 110.1, 729.5
I was able to bill these together with a modifier -59. I never had trouble unless the provider did not dictate something and in that case as all coders know " if its not dictated it didnt happen"!!!
Hope that helps