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Help with podiatry

  1. #1
    Default Help with podiatry
    Medical Coding Books
    I billed today's options for 11721 with a q8 modifier and the person is in a skilled nursing facility which is 31 place of service. My denial is missing required lcd part b secondary dx my dx were in order as follows 110.1,729.5,440.20 could someone please tell me what ia m doing wrong they are the only ins company denying this medicare paid them thanks

  2. #2
    Location
    Flint, Michigan
    Posts
    65
    Default
    That is confusing! I just learned that Medicare is now requiring a secondary dx but you have the correct dx.

    According to Medicare (I'm in Michigan), it states:
    ICD-9 CM code 110.1 must be reported as primary condition and the appropriate Q modifier showing that coverage criteria has been meet. In the absence of a systemic condition, one of the following must be listed to document medical necessity of the service:
    681.10 Unspecified cellutlities and abcess of toe
    681.11 Onychia and paronychia of toe
    703.0 Ingrowing nail
    719.7 Difficulty in walking
    729.5 Pain in limb
    781.2 Abnormality of gait

    I'll be watching this post carefully to see what others have to say!
    Sorry I can't be of more help!
    Marcia

  3. Default
    Quote Originally Posted by TCARBINO View Post
    I billed today's options for 11721 with a q8 modifier and the person is in a skilled nursing facility which is 31 place of service. My denial is missing required lcd part b secondary dx my dx were in order as follows 110.1,729.5,440.20 could someone please tell me what ia m doing wrong they are the only ins company denying this medicare paid them thanks
    If the patient has 440.20, the systemic is more indicative of the need for the RFC and is most likely expected by them as the secondary diagnosis pointer. The pain DX as secondary would really only be applicable if the systemic condition was not existent.
    ~Ursula, CPC~

  4. #4
    Location
    Flint, Michigan
    Posts
    65
    Default
    Good point! I over looked the 440.20. Sorry!

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