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Help with 11721 and Medicare

  1. #11
    Flint, Michigan
    Medical Coding Books
    This is a little late and I don't know what region you are in but for Michigan, Illinois, Wisconsin and Minnesota region, these are the guidelines:

  2. #12
    The E&M should have a 25 modifier then the 11721 should have the Q Modifier , also the last date seen by the PCP and the NPI of the Physician doing the 11721. Q Modifiers can be found on CMS website. without it it will be denied

  3. #13
    Thanks, Marcia. NGS has a similar document for our region.

  4. #14
    bakr00, thanks for the concise summary.

    Question. How do you accurately get the last date seen by the PCP? It's like a extra crazy data element they have stuck into this low reimbursement service. While some patients might be able to provide this date, you know if you give them a date soon enough they will put in an edit that will recoup the payment if they don't match up to a date of service from the PCP!

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