Vera Posted Wed 27th of February, 2013 18:23:38 PM
When you have a patient that is diabetic, and has an ulcer, you are supposed to code A9283, if you dispense a pneumatic boot - which is not reimbursable. This particular case is a little more complicated - we have a 90 year old diabetic patient with severe hallux valgus deformity, severe valgus foot type as well - which is the underlying reason for developing ulcers. She has developed an ulceration to the medial aspect of the left #1 metatarsal head. This has been an ongoing problem since the digit has been amputated.
Is it possible to code this in a way that will help the doctor get reimbursed for the boot? I believe the criteria to be reimbursed includes that it needs to support a weak or deformed body part? The patient does have a deformity, resulting in the ulcers?
Please advise. Thank you.
SuperCoder Answered Wed 27th of February, 2013 22:22:53 PM
We are working on this. Please be patient.
Vera Posted Fri 01st of March, 2013 18:50:18 PM
Thank you - I am very curious because this has come up more than once in our office.
SuperCoder Answered Mon 04th of March, 2013 10:31:55 AM
Code status is "N"; N = Non-covered Services. These services are not covered by Medicare.
Therefore it's extremely tough to get paid. However, you can bill the code with proper ICD code based on LCD policy, as per your state. The jurisdiction for this code is with DME MAC. Bill the diabetic ulcer, valgus foot and amputation status codes. Also, submit a letter to insurance exlaining the medical necessity in simple language. Some coders also try to bill the HCPCS with modifier GY, though that has no surity to attract payment.