Medical Coding

Can you please explain the Medicare Appeals process?

Orthotics are supposed to be statutorily not covered by Medicare unless they are attached to a brace. I was told to just append the KX modifier to the codes that are being billed for orthotics and I will get paid. Is this true and is it right to do this? Can I get in trouble?

Does a patient have to be “Homebound” in order to provide foot care services in the patient’s home?

Is it appropriate to remove the core of a porokeratosis or a nucleated callus every month or two and bill it to the insurance company with CPT code 11305?

Help! Can you please explain what is needed to determine the most appropriate E/M code to bill in the office based upon time?

APPEALING MEDICARE DECSIONS Once an initial claim determination is made participating physicians generally have the right to appeal. Physicians who do not take assignment have limited appeal rights. Beneficiaries my assign their appeal rights to Physicians who provide them with services or items.

Peripheral Neuropathy is the most common factor leading to amputation in people with diabetes. In diabetes, peripheral neuropathy is an anatomically diffuse process primarily affecting sensory and autonomic fibers.

Routine Foot Care, which includes trimming or debridement of the asymptomatic, dystrophic, mycotic, or normal toenails are covered by Medicare only when the patient has one of the Medicare-specified systemic diseases with clinically significant peripheral complications placing the patient “At Risk” for infection and/or injury if a non-professional attempts to trim or debride the nail.

“If orthotics are not covered by Medicare, if the KX modifier is appended to L3000-RT and L3000-LT, I am getting paid. Is it wrong to use the KX modifier to get paid for orthotics?”

What is the difference between an asterisk and a non-asterisk systemic disease with respect to “At Risk,” Routine Foot Care?