Hello,
I understand that in the CMS A52996 Routine Foot Care reference, the systemic ICDs with the asterisk (*) indicates that a managing provider and an approximate date last seen for the condition is required. I initially thought that the ones WITHOUT the asterisk, for example, I73.9 Peripheral vascular disease, unspecified, doesn't require those information; however, I'm starting to get denials and when my AR department called Novitas to get more information, they were told that a REFERRING provider is required, (it doesn't have to be a Managing provider), and that the Date last seen WAS NOT needed. My AR dept called again on a different day with the same denial and was told by a different person that the Referring provider is required AS WELL AS the Date Last Seen.
There are also encounters where the patient is a self referral, so there won't be a referring provider for me to add to the claim.
Can someone please advise me on how to proceed with these scenarios? I make sure to have a medical necessary ICD from Group 1 and a Q modifier on my RFC procedures. It's the referring provider vs managing provider vs date last seen that I'm unsure with. It seems like every time I think I got podiatry coding down, something else pops up and I feel like I'm back to square one, so I would really appreciate any help!
Thank you!
I understand that in the CMS A52996 Routine Foot Care reference, the systemic ICDs with the asterisk (*) indicates that a managing provider and an approximate date last seen for the condition is required. I initially thought that the ones WITHOUT the asterisk, for example, I73.9 Peripheral vascular disease, unspecified, doesn't require those information; however, I'm starting to get denials and when my AR department called Novitas to get more information, they were told that a REFERRING provider is required, (it doesn't have to be a Managing provider), and that the Date last seen WAS NOT needed. My AR dept called again on a different day with the same denial and was told by a different person that the Referring provider is required AS WELL AS the Date Last Seen.
There are also encounters where the patient is a self referral, so there won't be a referring provider for me to add to the claim.
Can someone please advise me on how to proceed with these scenarios? I make sure to have a medical necessary ICD from Group 1 and a Q modifier on my RFC procedures. It's the referring provider vs managing provider vs date last seen that I'm unsure with. It seems like every time I think I got podiatry coding down, something else pops up and I feel like I'm back to square one, so I would really appreciate any help!
Thank you!