Search Results

I recently dispensed surgical dressings to a Humana patient and all the claims were denied, because they considered part of the global service for the debridement I provided. What recourse do I have? My only thought is in the future to have patients only receive their post operative dressings on a post operative day, rather than on their date of surgical debridement. What do you suggest?

One of my patients showed me a new intriguing wound or incisional closure system. Is this something I can bill in addition to my surgery?

Can I use a tibial fracture orthosis for a non-tibial fracture, and can I add a soft tissue interface (below knee) L2820?

I have a question about shockwave therapy for Musculoskeletal indications (0101T) and for wounds (0512T). Are these covered by Medicare? What about private insurance? If these are covered now, how do I know if the coverage is pulled later on that I won't be subject to claw backs?

If a custom DME product, such as a Rx brace or diabetic therapeutic shoes/ inserts, are not picked up by a patient what is the recourse the provider has regarding billing? I understand that when a patient is deceased or there's been changes in deformity based on the initial DME product prescription that billing can be provided for invoice cost. But in this case, if the product is never picked up by the patient, what is the best practice for this situation? Can you bill the patient at all at a certain time frame, that is, 60 or 90 days of having the DME in the office and have already been invoiced by the vendor and yet have not billed insurance because it was not dispensed.

What is the proper code for taking a cast or bio foam or scan for a foot or ankle foot orthotic?

My question is this: when a provider is considering the use a of biologic the LCD if available or the required parameters under the product use guidelines must be followed. Not every wound requires a biologic wound graft. I get that, but what I do not get is whether or not there is an actual standard of care, local or national, that a provider must adhere to when using these grafts? Or should they just use their better judgement, clinical experience, morality and medical integrity rather than how much they can profit from performed wound care using biologics?

I was just wondering if a specialist such as a podiatrist must indicate CPT/HCPCS codes that may be used prior to seeing an HMO patient (new or established) in the prior authorization provided to the patient's primary MD/DO. Because when referrals are sent to the office by the patient's primary care provider sometimes all we get is CPT code E/M 99205 and 99215 (for multiple visits). Neither of these CPT codes are rarely if ever used for any new or established patients in the office and hence cannot be billed. New patients that are scheduled usually try to indicate their complaint when making an appointment, but even with that said the prior authorization CPT codes may only include E/M codes 99202-04 and 99212-14 based on the complaint and if foot care is required then CPT codes 11719, G0127, 11720-21, and/or 11055-57 may be included as well. But again, it is hard to determine exactly which CPT codes need authorization especially on the new patient. This is not as difficult with the established patient since most prior authorizations are good for up to a year. I have heard that certain carriers will allow back dating authorizations for 6 months especially when there are cases where certain codes were not authorized. I have also heard that all the specialist has to state on the prior authorization is "diagnose and treat" which will cover all required CPT/HCPCS codes for a particular date of service whether the patient is new or established to cover services. Is that correct?

I heard there is a new HCPCS code L1952. What is this new code and how is it different from the existing code(s) maybe L1951? I also don't have a fee schedule for this, how do I find this?

Today I heard that the CTP policy which was to become effective Monday April 13 has been proposed again. Is this true and if so, why did they wait until the last minute?