Wiki Help with podiatry

[TCARBINO]

I billed today's options for 11721 with a q8 modifier and the person is in a skilled nursing facility which is 31 place of service. My denial is missing required lcd part b secondary dx my dx were in order as follows 110.1,729.5,440.20 could someone please tell me what ia m doing wrong they are the only ins company denying this medicare paid them thanks

 

[MarciaH]

That is confusing! I just learned that Medicare is now requiring a secondary dx but you have the correct dx.

According to Medicare (I'm in Michigan), it states:
ICD-9 CM code 110.1 must be reported as primary condition and the appropriate Q modifier showing that coverage criteria has been meet. In the absence of a systemic condition, one of the following must be listed to document medical necessity of the service:
681.10 Unspecified cellutlities and abcess of toe
681.11 Onychia and paronychia of toe
703.0 Ingrowing nail
719.7 Difficulty in walking
729.5 Pain in limb
781.2 Abnormality of gait

I'll be watching this post carefully to see what others have to say!
Sorry I can't be of more help!
Marcia

 

[tammster]

I billed today's options for 11721 with a q8 modifier and the person is in a skilled nursing facility which is 31 place of service. My denial is missing required lcd part b secondary dx my dx were in order as follows 110.1,729.5,440.20 could someone please tell me what ia m doing wrong they are the only ins company denying this medicare paid them thanks

If the patient has 440.20, the systemic is more indicative of the need for the RFC and is most likely expected by them as the secondary diagnosis pointer. The pain DX as secondary would really only be applicable if the systemic condition was not existent.

 

[MarciaH]

Good point! I over looked the 440.20. Sorry!