Wiki Nail Debridement for Hospice Patient

[jerrypratt]

We bill for a podiatrist who sees patients in various nursing facilities. Among those patients are some in hospice. For a diabetic Medicare patient we are coding a 11720 or 11721 with the Q-modifier, GW modifier, PCP and date last seen by PCP.

Medicare is flatly denying all of our nail debridements for hospice patients. Any help would be greatly appreciated!!

 

[Peter Davidyock]

What dx's are you using?

 

[kimscoding]

The diagnosis would need to meet medical necessity... I did a google search on "medical necessity for nail debridement" and this is what it gave me

http://oig.hhs.gov/oei/reports/oei-04-99-00460.pdf

Try this "MCR Payments for Nail Debridement Services" this might help.

 

[jerrypratt]

We are using 110.1, 729.5 and 250.70 or 110.1, 703.0 and 250.70. Thanks for the question!

 

[Jana Lee]

For Hospice patients, you need to use GW and GV modifiers, then medicare will pay

 

[msr1984]

the dx order has to be 110.1, 250.60 or 250.70 for the 11721-Q?GW

i know for Palmetto, the prim dx has to come from list A and secondary dx from list B in order to for the claim to be medically necessary. The dx order linkage on podiatry is extremely important