Help with 11721 and Medicare

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suemt

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Hi, all. Medicare has changed this one around again.

I KNOW we are coding this right, but it keeps getting rejected by Medicare. I suspect the biller isn't doing it right, or her system isn't processing it correctly. Can anyone show/describe EXACTLY how this is supposed to show up on a 1500 bill?

Thanks in advance!

Sue
 
It would help to know more information such as the visit and procedure note and the codes you submitted plus dx code and any modifiers as well as the denial reason.
 
I find using the Medicare C snap web site will gives me a more detailed denial reason. Our billers who don't use this site on a regular basis tend to miss items that could be easily fixed.
 
Medicare does not cover routine foot care, unless there are other contributing factors to the pt's medical condition that provide medical neccessity, such as qulifying for class A, B, or C findings. I don't recall ever being denied when my "Q" modifier is on claim.
 
Medicare C Snap Website?

twoerpel said:
I find using the Medicare C snap web site will gives me a more detailed denial reason. Our billers who don't use this site on a regular basis tend to miss items that could be easily fixed.
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I've never heard of this. Can you provide the url? Can anyone use it?
 
PLAIDMAN said:
Medicare does not cover routine foot care, unless there are other contributing factors to the pt's medical condition that provide medical neccessity, such as qulifying for class A, B, or C findings. I don't recall ever being denied when my "Q" modifier is on claim.
Click to expand...

With all the new information now required (provider name, NPI, date last seen, etc.) something is getting tripped up. If you can believe it, last time our biller called to follow up the Medicare rep told them to resubmit all the claims WITHOUT modifiers (the Q). She doesn't believe me that they will all be rejected - again.
 
suemt said:
With all the new information now required (provider name, NPI, date last seen, etc.) something is getting tripped up. If you can believe it, last time our biller called to follow up the Medicare rep told them to resubmit all the claims WITHOUT modifiers (the Q). She doesn't believe me that they will all be rejected - again.
Click to expand...

Seriously, I've submitted claims with ALL the "right" diagnoses, the timing taken into account, the Q class finding modifier, the PCP and date of last visit, notes, hoops, etc., and had the claims rejected; then I've turned around and submitted with only partially "right" diagnoses, no notes, no MD, nothing but a GA modifier, and darn if they didn't pay it. Sigh.
 
jodygo said:
Seriously, I've submitted claims with ALL the "right" diagnoses, the timing taken into account, the Q class finding modifier, the PCP and date of last visit, notes, hoops, etc., and had the claims rejected; then I've turned around and submitted with only partially "right" diagnoses, no notes, no MD, nothing but a GA modifier, and darn if they didn't pay it. Sigh.
Click to expand...

Jodygo, the problem is that they may very well come after you in a post payment review and recoup the money. This has happened to this provider a couple times over the past several months. Medicare admits the problem was with their system, but too bad, you have to give back the money. So very frustrating for such low reimbursement to begin with.

Thanks for your feedback. At least it confirms that I'm not completely crazy!

Sue
 
The E&M should have a 25 modifier then the 11721 should have the Q Modifier , also the last date seen by the PCP and the NPI of the Physician doing the 11721. Q Modifiers can be found on CMS website. without it it will be denied
 
bakr00, thanks for the concise summary.

Question. How do you accurately get the last date seen by the PCP? It's like a extra crazy data element they have stuck into this low reimbursement service. While some patients might be able to provide this date, you know if you give them a date soon enough they will put in an edit that will recoup the payment if they don't match up to a date of service from the PCP!
 
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