Podiatry denials of 11721

urbach34@yahoo.com

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Youngstown, OH
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I have recently taken over coding for Podiatry...which I have never done before! Our follow-up ladies have been bringing me denials for code 11721 (Debridement of nails) when it is being done at the same time as other procedures. The example I have in front of me is as follows:

97597-Lt-59
11721

Icd 9 dx codes:
707.8
110.1
250.80
459.31
459.81

97597 was linked to all dx other than 110.1...and 11721 was linked to all but 707.8.

I know there are rules regarding primary and secondary dx, but thought that I had that covered. Any info would be greatly appreciated!! I've been searching for a good Podiatry coding link, but haven't found a "go to" source yet...any suggestions?!?
 

dclark7

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For Medicare care patients make sure to read your MAC's LCD on Routine Foot Care. Just using NGS Jurisdiction K as an example these are the reasons your claim would be denied:
1) Modifier 59 should be on 11721
2) 11721 requires a modifier Q7, Q8 or Q9, these modifiers show that the patient has met the classification requirements for routine foot care
3) Per the NGS LCD codes 250.8x and 459.x are not on the covered diagnosis list

Since each MAC has their own LCDs you would need to verify the coverage requirements with your MAC, but they should be similar. And other insurance companies will have their own requirements.
 

espressoguy

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Tacoma, WA
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This should be coded as:

97597
11721-59

The debridement does not need a laterality modifier because debridement is coded by size and depth, not location.

The 59 modifier goes on the 11721 due to CCI edits.

As far as a resource, when I first started coding podiatry I spent a lot of time at this website Podiatry Today. Also, make sure you establish a relationship with your provider. I code for 3 podiatrists and they all know their stuff. In fact one of them taught coding for 8 years in a previous position.

ETA: Plus what Doreen said. :D
 
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