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my question I believe is simple however I will tell you right away that we are having some complication when billing these two codes together and that is why Im here begging for help. Hypothetically speaking if a patient has diabetes E11.41 and PVD I73.9 did I mention this patient insurance is Medicare. This patient came in and we billed out 11721 Q9 59 and also 11056 Q9. MEDICARE is denying these claims... also to let you know we also billed out with the GY modifier on both 11721 and 11055.. please help thanks so much

SuperCoder Answered Tue 25th of October, 2016 03:52:40 AM

Hi Cindy,

The billed codes with modifiers seem correct. However, with the patient condition like diabetes mellitus, routine procedures are covered only if the patient is under the active care of a doctor of medicine or osteopathy who documents the condition. So you also need to submit these details as well and check payer policy as well. Also check with the below provided link and with your documentation for further clarification. For more clarity you can send us with some more details of your documentation. Thank you.

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35138&ver=19&Date=&DocID=L35138&bc=iAAAABAAAAAAAA==&

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