Podiatry Coding Help

[Leerandir549]

I'm a bit new to the coding world and I'm really struggling with a couple of claims right now and nothing I do seems to be able to get these claims through. I've never had issues before with claims that were identical to these. Any help at all would be much appreciated.

 

The first claim is for routine foot care. It's been denied for "missing information" and the rep form CMS said that I'm missing a modifier.

DX:

A. L60.0

B. L60.2

C. L03.031

D. L03.032

E. M79.674

F. M79.675

 

CPT's:

99213-25

DX Pointers: A-B-E-F

11721-Q8

DX Pointers: A-B-E-F

 

 

 

The second claim is for a total nail excision with matrixectomy. I've had three of these claims come back with the office visit being denied as inclusive when I never have before. But this claim is a bit different. They've denied everything else, including the matrixectomy, as inclusive to the office visit and I am completely stumped.

 

DX: 

A. L60.0

B. L03.032

C. L03.042

D. M79.675

 

CPT's:

99214-25

DX Pointers: A-B-C-D

11750-TA

DX Pointers: A-B-C-D

96372-LT

DX Pointers: A-B-C-D

 

HCPCS

J0670-LT

DX Pointers: A-B-C-D

 

 

Again, any help at all would be GREATLY appreciated.

[rev ronin]

As far as modifiers on foot care go, there was a series of them that I last used ~7 years ago. I do know that Medicare had their own weird set of coding, and that I had a cheat sheet for what codes and modifiers to use based on what I did

If they're going to include the procedure in the E&M, make sure you roll the time into the procedure and code based on time, although I doubt that will capture all the revenue lost.  Alternatively, drop the E&M and bill for procedure only.  Alternatively, have you put the -25 on the other CPT code?

Disclaimer: I work with one insurer who does things very simply, and I've learned billing and coding on the job. YMMV, and definitely talk to someone about what's legal.  I would NEVER bill medicare for anything without having someone certified look over it to make sure neither one of us goes to jail.