lorettac
Networker
Hello everyone, hope you could help me to understand this claim validation edits.
A Medicare patient was seen (initial office visit) by our podiatrist and performed trim/removal of corns on right 2nd digit. An foot x-ray was performed for the right foot pain.
Reported E&M/CPT - 99203 (Modifier 25), 73630 (Modifier RT), 11056, with reported Diagnosis - M79671, M2021, M2141, M2142, L84
However, our billing system (CareCloud) rejected with a claim validation edits - DATE LAST SEEN IS REQUIRED FOR THIS PROCEDURE AND THIS PAYER. Claim was not even be able to submit to the payer without this information.
I understand that Medicare does not cover routine foot care which removal of corns and calluses is part of routine foot care, and I am expecting a denial on this procedure only. Patient does not have any metabolic, neurologic, and peripheral vascular disease, so I thought the last seen date by another MD or DO within the last 6 months should not be required for this incident. Therefore, the above claim should be able to submit without the last seen date information. I am confused by this claim edits.
If someone could explain to me this "Last Seen Date" is apply only to specific diagnosis OR this is apply to all routine foot care procedures and doesn't matter with any diagnosis, OR this is the billing system errors? Besides, what if the patient did not have a recent visit within the last 6 months, like the above patient who had the last visit two years ago, what information I should report for the Last Seen Date?
Thank you very much indeed for any help!
A Medicare patient was seen (initial office visit) by our podiatrist and performed trim/removal of corns on right 2nd digit. An foot x-ray was performed for the right foot pain.
Reported E&M/CPT - 99203 (Modifier 25), 73630 (Modifier RT), 11056, with reported Diagnosis - M79671, M2021, M2141, M2142, L84
However, our billing system (CareCloud) rejected with a claim validation edits - DATE LAST SEEN IS REQUIRED FOR THIS PROCEDURE AND THIS PAYER. Claim was not even be able to submit to the payer without this information.
I understand that Medicare does not cover routine foot care which removal of corns and calluses is part of routine foot care, and I am expecting a denial on this procedure only. Patient does not have any metabolic, neurologic, and peripheral vascular disease, so I thought the last seen date by another MD or DO within the last 6 months should not be required for this incident. Therefore, the above claim should be able to submit without the last seen date information. I am confused by this claim edits.
If someone could explain to me this "Last Seen Date" is apply only to specific diagnosis OR this is apply to all routine foot care procedures and doesn't matter with any diagnosis, OR this is the billing system errors? Besides, what if the patient did not have a recent visit within the last 6 months, like the above patient who had the last visit two years ago, what information I should report for the Last Seen Date?
Thank you very much indeed for any help!