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Nail Debridement for Hospice Patient

  1. Default Nail Debridement for Hospice Patient
    Medical Coding Books
    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!!

  2. #2
    What dx's are you using?

  3. #3
    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

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

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

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

  6. #6
    Honolulu, HI
    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

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