GJackson
Networker
I have a question about MCR patients and those routine foot care codes ? i understand if they meet Q7,Q8 or Q9 and appending those modifiers. or GY OR GA etc. I get conflicting answers on this question ? IF the patient has a DM diagnosis and has a covered diagnosis am do you have to use a modifier to get it paid ? Here's an example ?
I am doing 99203-25 and 11721 (nail Debridement) with a diagnosis of L60.3 Nail Dystrophy and E11.42 DM w/polyneuropathy and E11.40 DM w/neuropathy, Unsp.
So the DM with polyneuropathy is on the covered diagnosis list do I need any other modifiers there is no abn on file signed for this day?? Ihave included the DLS and provider a1c info also on the claim. is there anything else ?
appreciate any insight ?
just extra: some copy from my documentation:
Patient presents in office as a new patient for BILATERAL diabetic foot exam and foot pain. Onset was several years ago, gradually getting worse. Pain is 3/10 and is burning in nature. Patient denies any injury or trauma. Patient denies any treatment. His last A1C was 6.0 on 03/26/23. He does have lower extremity weakness and is going to physical therapy.
Procedures
Nails 1 through 10 sharply, mechanically debrided and trimmed with nail nippers and curette as needed due to dystrophic nails and patient's comorbidities. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of soft tissue infection, drainage, or malodor present.
Case reviewed and discussed with patient, all questions and concerns were answered to patient satisfaction.
Etiology of patient's condition was reviewed. Physical exam was performed with findings of type 2 diabetes with neuropathy and nail dystrophy. At risk nail care is provided at this time with debridement the nails performed x10 without incident. Patient is instructed to continue to monitor his feet daily for any changes and to notify podiatry of any wounds or signs of infection. Patient to return to podiatry clinic as needed.
Instructions given to patient to present to emergency room if clinical signs of infection such as fever, chills, nausea, or vomiting present. Patient verbalized understanding.
Diagnoses and all orders for this visit:
1. Diabetic neuropathy
2. Nail dystrophy
3. Diabetic polyneuropathy associated with type 2 diabetes mellitus (HCC)
I am doing 99203-25 and 11721 (nail Debridement) with a diagnosis of L60.3 Nail Dystrophy and E11.42 DM w/polyneuropathy and E11.40 DM w/neuropathy, Unsp.
So the DM with polyneuropathy is on the covered diagnosis list do I need any other modifiers there is no abn on file signed for this day?? Ihave included the DLS and provider a1c info also on the claim. is there anything else ?
appreciate any insight ?
just extra: some copy from my documentation:
Patient presents in office as a new patient for BILATERAL diabetic foot exam and foot pain. Onset was several years ago, gradually getting worse. Pain is 3/10 and is burning in nature. Patient denies any injury or trauma. Patient denies any treatment. His last A1C was 6.0 on 03/26/23. He does have lower extremity weakness and is going to physical therapy.
Procedures
Nails 1 through 10 sharply, mechanically debrided and trimmed with nail nippers and curette as needed due to dystrophic nails and patient's comorbidities. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of soft tissue infection, drainage, or malodor present.
Case reviewed and discussed with patient, all questions and concerns were answered to patient satisfaction.
Etiology of patient's condition was reviewed. Physical exam was performed with findings of type 2 diabetes with neuropathy and nail dystrophy. At risk nail care is provided at this time with debridement the nails performed x10 without incident. Patient is instructed to continue to monitor his feet daily for any changes and to notify podiatry of any wounds or signs of infection. Patient to return to podiatry clinic as needed.
Instructions given to patient to present to emergency room if clinical signs of infection such as fever, chills, nausea, or vomiting present. Patient verbalized understanding.
Diagnoses and all orders for this visit:
1. Diabetic neuropathy
2. Nail dystrophy
3. Diabetic polyneuropathy associated with type 2 diabetes mellitus (HCC)