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THE DOCTOR LINE
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- Does CIGNA have it in their plan that a surgical avulsion of a toenail is routine foot care?In General News9 de octubre de 2024This is my first thought, what diagnosis did you use exactly use to justify this procedure, a S diagnosis? This minor procedure CPT 11730 requiring anesthesia is a procedure and then removal of a nail for a traumatic injury CIGNA should pay but again what was diagnosis code paired with the CPT 11730. Each plan has different aspects that the employer may and may not cover. Ask CIGNA for the specific insurance your patient had for their plan summary document as each employer picks what is covered as an ERISA plan, unfortunately certain codes may be excluded. If not covered it is patient responsibility.02
- Mock AuditIn General News·9 de octubre de 2024Any advice on who to contact to have a mock audit performed?0213
- Does CIGNA have it in their plan that a surgical avulsion of a toenail is routine foot care?In General News9 de octubre de 2024It was paired with ICD-10-CM diagnosis L60 could that be a reason?0
- Second pair of therapeutic shoes in same calendar yearIn DME Coding·8 de octubre de 2024My patient wants a second pair of shoes this calendar year. They are willing to pay for It because their secondary insurance has agreed to pay part or all of the costs after Medicare rejects the claim. Is there a special modifier I can use to let Medicare know that it is being submitted only for purpose of rejection only?029
- What is a MUE and why care?In General News·4 de octubre de 2024A colleague said you need to understand what a MUE is and sure enough an insurance denied CPT 64455 when billed with RT snd LT on two lines, the denial was based on its MUE, please explain?0110
- Does "0" day global toe amputations pertain to all insurances?In Surgical Coding·30 de septiembre de 2024While Medicare has classified toe amputations (CPT 28820 & 28825) with a "0" day global why does this not apply to all insurances?0119
- Apealing Medicare UPIC, can you provide advice?In Wound Care Coding29 de septiembre de 2024When you receive a UPIC (Unified Program Integrity Contractor) audit, CMS (Centers for Medicare & Medicaid Services have intensified their efforts to identify organizations with improper billing practices, so they feel you are not billing properly. The UPIC contracts operate in five (5) separate geographical jurisdictions in the United States and should identify who they are, you should seek a healthcare attorney on your own with experience in UPIC's and/or your administrative defense fund advisors before you proceed. You usually are given 15 days from the date the letter is written, if you plan on appealing, make sure you timely notify in writing the UPIC that you are appealing their findings. Get a confirmation they received your request to appeal their determination.10
- Apealing Medicare UPIC, can you provide advice?In Wound Care Coding·28 de septiembre de 2024I received a UPIC audit in the mail today for grafts I provided a year ago. They want a lot of money back. I know I documented well, can you suggest or advise what my steps are in appealing this 100% denial?0116
- Reimbursement for Quality Measure Met CodesIn MIPS·27 de septiembre de 2024Are the “G” codes submitted to a patient’s insurance company to show a Quality MIPS Measure is met reimbursable by insurance? Or, do you get paid more from the insurance if you bill these Measure Met codes?0121
- Do I need to bill CPT 99024 in global period on Medicare patients?In Surgical Coding·24 de septiembre de 2024I was reading in the global surgery packet on the CMS MLN booklet from December 2023, indicates that if the patient has Medicare, they require the CPT code 99024 to be reported for postoperative visits. Is this still true?0116
- New Compression Treatment CMS Guidelines for LymphedemaIn DME Coding·20 de septiembre de 2024Can an DME expert provide clarification on dispensing compression garments in the office as a podiatrist? I researched the topic and came across this article from CMS: MM13286 - Lymphedema Compression Treatment Items: Implementation (cms.gov) Thanks0112
- DME billing, can we use the company name and not the doctor when billing for DMERC?In DME Coding10 de septiembre de 2024This can get a bit complicated, so please provide more information as to the relationship of the dispensing to the supplier and where the device was dispensed (office, SNF, patient's home), is the dispenser reassigning their benefits as a 1099 consultating provider to the practice or a W2 employee?02
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