Wiki Podiatrist billing Medi-cal California

[Beeper1106]

I need help I am working for a Podiatrist that is seeing medi-cal pts for 11720 or 11721 and we can't get paid we first billed B35.1 which is needs to be a secondary code per Medi-cal guidelines so I rebilled claim with L60.3 and B35.1 as secondary and we are still getting denied. We have the TAR approved but still Denied due to diagnosis.. Anyone else have this issue or anything I can rebill with

 

[Chelle-Lynn]

Podiatry services with Medi-Cal are very difficult to get paid even with a TAR. Generally they will not consider L60.3 to meet the diagnosis requirement for podiatry services to be paid. Their clause for diagnosis is very vague, see below:


Allother podiatry (beyond 99201-99213) services are subject to authorization and are limited to medicaland surgical services necessary to treat disorders of the feet, ankles ortendons that insert into the foot; that are secondary to or complicatingchronic medical diseases; or that significantly impair the ability to walk.

My guess is that they are looking for the chronic disease or significant impairment diagnosis code.
Medi-Calfee-for-service TAR approval is restricted to the following conditions:


· Disorders of the feet secondary to orcomplicated by chronic disease
· Disorders of the feet, which significantlyimpair the ability to walk

 

[AAPC261]

I need help I am working for a Podiatrist that is seeing medi-cal pts for 11720 or 11721 and we can't get paid we first billed B35.1 which is needs to be a secondary code per Medi-cal guidelines so I rebilled claim with L60.3 and B35.1 as secondary and we are still getting denied. We have the TAR approved but still Denied due to diagnosis.. Anyone else have this issue or anything I can rebill with

billed B35.1 WITH L60.0 YPU WILL GET PAID

 

[greatbiller]

Caveat to changing diagnosis to a payable code - medical records must support the diagnosis code on the claim. Changing a code to a payable code without supporting documentation is fraudulent billing.