Routine foot care billing

Routine foot care : 11055,  11056, 11057,  11719,  11720,  11721, G0127

Routine foot care is not a covered Medicare benefit. Medicare assumes that the beneficiary or caregiver will perform these services by themselves, and therefore, they are excluded from coverage. Medicare allows exceptions to this exclusion when medical conditions exist that place the patient at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care in the following situations:

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Insurance Plans

HMO plans

With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you need a referral before you can see any other health care professional, except in an emergency. Visits to health care professionals outside of your network typically aren’t covered by your insurance.

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NCCI Modifiers

National Correct Coding Initiative (NCCI)

The set of edits developed by CMS where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.

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Timeframe between Annual Wellness Visits (AWVs)

The exact timeframe between AWV is a little confusing.  Annual Wellness Visits (AWVs) are covered by Medicare at 12-month intervals. This means that 11 full calendar months must pass after the month in which a beneficiary had received an AWV.

For example, if AWV was performed on Jan 31, 2016 the patient is eligible to AWV starting from Jan 1, 2017

The exact day of the month doesn’t matter. AWV could have been done on Jan 1 or Jan 31 (or any other day of January) and the patient will be eligible for new AWV starting from January 1 next year.

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Preventive Care Services

CPT 99381-99387 – Initial Comprehensive Preventative Medicine evaluation and management.
CPT 99391-99397 – Periodic Comprehensive Preventative Medicine reevaluation and management.

Includes care for preexisting conditions or minor problems. Excludes behavior change intervention (99406-99409)

(better known to offices as complete Physical Exams, Well Checks, routine physical, annual physical, annual exam, well exam, routine exam, full physical, annual routine physical)

Risk factor and behavior change modification.
CPT 99401–99405 Preventive medicine counseling and/or risk factor reduction and behavioral change intervention services provided at an encounter separate from the preventive medicine examination in areas such as family problems, diet, and exercise.

CPT 99406–99407 Smoking and tobacco use cessation counseling.

CPT 99408–99409 Alcohol and/or substance abuse structured screening.

Medicare doesn’t cover preventative services.

The CMS recognizes two HCPCS codes for billing for behavioral counseling for obesity

G0447 – face-to-face behavioral counseling for obesity, 15 minutes

G0473 – face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.


Transitional Care Management

To increase the quality of patient care and reduce hospital re-admissions.

CPT Code 99495 – TCM services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)
CPT Code 99496 – TCM with high medical decision complexity (face-to-face visit within 7 days of discharge)

The 30-day TCM period begins on the date the beneficiary is discharged from the inpatient hospital setting and continues for the next 29 days.

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Collection

COLLECTION

The purpose of collection is to find out what happened to the Dr’s money. Why is the claim not paid? What can we do to get a payment? You need to try and act as completely as possible: try to make sure that the actions you are performing will facilitate either a payment or finalization of the claim. The point is not to keep the claim open.

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Incident to Billing

Currently, there are two ways in which to bill Medicare for Non-physician Providers (NPP) services: direct (under the NPP`s name and NPI) and incident to (under supervising physician`s name and NPI).

“Incident to” services are defined as those services that are furnished incident to physician professional services in the physician’s office (whether located in a separate office suite or within an institution) or in a patient’s home.

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