Page 1 of 2 12 LastLast
Results 1 to 10 of 14

Help with 11721 and Medicare

  1. #1
    Default Help with 11721 and Medicare
    Medical Coding Books
    Hi, all. Medicare has changed this one around again.

    I KNOW we are coding this right, but it keeps getting rejected by Medicare. I suspect the biller isn't doing it right, or her system isn't processing it correctly. Can anyone show/describe EXACTLY how this is supposed to show up on a 1500 bill?

    Thanks in advance!

    Sue

  2. #2
    Location
    Columbia, MO
    Posts
    12,837
    Default
    It would help to know more information such as the visit and procedure note and the codes you submitted plus dx code and any modifiers as well as the denial reason.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Madison, Wisconsin
    Posts
    19
    Default
    I find using the Medicare C snap web site will gives me a more detailed denial reason. Our billers who don't use this site on a regular basis tend to miss items that could be easily fixed.

  4. #4
    Default
    Medicare does not cover routine foot care, unless there are other contributing factors to the pt's medical condition that provide medical neccessity, such as qulifying for class A, B, or C findings. I don't recall ever being denied when my "Q" modifier is on claim.

  5. #5
    Default Medicare C Snap Website?
    Quote Originally Posted by twoerpel View Post
    I find using the Medicare C snap web site will gives me a more detailed denial reason. Our billers who don't use this site on a regular basis tend to miss items that could be easily fixed.
    I've never heard of this. Can you provide the url? Can anyone use it?

  6. #6
    Default
    Quote Originally Posted by PLAIDMAN View Post
    Medicare does not cover routine foot care, unless there are other contributing factors to the pt's medical condition that provide medical neccessity, such as qulifying for class A, B, or C findings. I don't recall ever being denied when my "Q" modifier is on claim.
    With all the new information now required (provider name, NPI, date last seen, etc.) something is getting tripped up. If you can believe it, last time our biller called to follow up the Medicare rep told them to resubmit all the claims WITHOUT modifiers (the Q). She doesn't believe me that they will all be rejected - again.

  7. Default
    Quote Originally Posted by suemt View Post
    With all the new information now required (provider name, NPI, date last seen, etc.) something is getting tripped up. If you can believe it, last time our biller called to follow up the Medicare rep told them to resubmit all the claims WITHOUT modifiers (the Q). She doesn't believe me that they will all be rejected - again.
    Seriously, I've submitted claims with ALL the "right" diagnoses, the timing taken into account, the Q class finding modifier, the PCP and date of last visit, notes, hoops, etc., and had the claims rejected; then I've turned around and submitted with only partially "right" diagnoses, no notes, no MD, nothing but a GA modifier, and darn if they didn't pay it. Sigh.

  8. #8
    Default
    Quote Originally Posted by jodygo View Post
    Seriously, I've submitted claims with ALL the "right" diagnoses, the timing taken into account, the Q class finding modifier, the PCP and date of last visit, notes, hoops, etc., and had the claims rejected; then I've turned around and submitted with only partially "right" diagnoses, no notes, no MD, nothing but a GA modifier, and darn if they didn't pay it. Sigh.
    Jodygo, the problem is that they may very well come after you in a post payment review and recoup the money. This has happened to this provider a couple times over the past several months. Medicare admits the problem was with their system, but too bad, you have to give back the money. So very frustrating for such low reimbursement to begin with.

    Thanks for your feedback. At least it confirms that I'm not completely crazy!

    Sue

  9. #9
    Location
    Madison, Wisconsin
    Posts
    19
    Default
    To access Medicare C snap log in to https://www.medicareinfo.com/apps/cms/home.do. I find this web page VERY helpful.

  10. #10
    Default
    Quote Originally Posted by twoerpel View Post
    To access Medicare C snap log in to https://www.medicareinfo.com/apps/cms/home.do. I find this web page VERY helpful.
    Thanks, twoerpel! This site is only for WPS providers. If there is any particular information from the site you think might be helpful, please feel free to post it.

    Sue

Page 1 of 2 12 LastLast

Similar Threads

  1. Podiatry denials of 11721
    By urbach34@yahoo.com in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 11-12-2015, 07:25 AM
  2. Q-modifier needed for 11721 with 110.1?
    By jek521 in forum Podiatry
    Replies: 1
    Last Post: 01-13-2014, 04:05 PM
  3. Again--billing issues with 11056 and 11721
    By ollielooya in forum Podiatry
    Replies: 4
    Last Post: 04-17-2013, 09:44 AM
  4. CPT Code 11721
    By phillyfan536 in forum Podiatry
    Replies: 5
    Last Post: 01-17-2012, 09:11 AM
  5. 11721?
    By MarciaH in forum Podiatry
    Replies: 6
    Last Post: 08-28-2009, 05:40 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.