Search Results

I received a CERT audit, and they are requesting items which are part of my medical record, what should I do?

Total Contact casting (CPT 29445) would be amended with a 59 as the first modifier (as the payment and distinct separate service). It would then have LT as the secondary modifier. The ICD10 would then need to be the appropriate LT for depth and site. For the right side the appropriate depth CPT code (e.g. 11042) would be billed and modified with RT modifier again using the correct ICD10 signaling the correct depth and site of that ulcer. The rationale here is that the cast (29445) is according to the Correct Coding Initiative a component of the 11042 and thus not separately payable. Use of the 59 on the LT and and the site modifier on both claim lines would signal to the carrier that because of the separate site, there is an exception to the CCI and thus both are payable.

Yes, TCC CPT code 29445 would have a left foot and leg ICD-10-CM diagnosis. Because of bundling concerns, two modifiers would be needed, Modifier 59 and LT appended to the procedure, 29445-LT-59. For the right foot ulcer debridement, it is necessary to show a diagnosis the right foot only, ie: L97.512 Non-pressure chronic ulcer of other part of right foot with fat layer exposed and that diagnosis is only paired with CPT 11042.

Can I get reimbursed for a total contact cast (TCC) on the left foot and leg that is unrelated to the ulcer debridement on right foot?

No. In light of the initial procedure, L3000, not being a covered service, the billing of CPT 97763 would not be paid. Additionally, if the patient did in fact meet the criteria for the use of custom functional foot orthotics, L3000, the dispensing and education on the use of the devices would be included in the billing of L3000.

I coded and billed for CPT 97763, Orthotic Management, and training for a Medicare patient who was dispensed a pair of custom foot orthotics. While the patient did not meet the criteria for the foot orthotics since the orthotics were not being placed into a shoe attached to a leg brace, can I still bill for the management and training?

No. Only time spent on the day of the patient’s encounter can be counted towards the time spent with the patient. Additionally, reviewing labs, outside reports, consultations, speaking with physicians, or providing coordination of care on the day of the encounter can be counted towards the time spent and the level of E&M coded for.

If I am reviewing a patient’s chart the day before since I know it is going to be a complicated visit, knowing an increased amount of time will be spent with the patient, am I entitled to bill for that?

No. The provider that sees a patient must be credentialed by the carrier in order to bill for the services. The NPI for the provider who provides the services is placed in box 24J on a HCFA-1500 form. The provider can’t provide these services under any special agreement such as locum tenens.

If my associate sees a patient and they are not credentialed by the insurance plan that the patient has, can the claim be submitted under my name and NPI number?

They are correct in that Medicare requires the patient to be under a comprehensive plan of care for diabetes. If the primary care physician or their PA or NP is referring the patient to an endocrinologist for treatment of their DM, then the PCP is correct. You need to coordinate with the endocrinologist’s office.

My patient’s internist refuses to agree/attest to my documentation. They say they are not treating the patient’s diabetes, and I should communicate with the patient’s endocrinologist. What should I do?