StephanieGladney
New
Ins is denying a 11750 with L60.0 as "routine nail care". Tried sending with additional M79.674 for pain but still denying. Any ideas on how what is not working here?
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Wiki Guidance on 11750 for ingrown toenail
- Thread starter StephanieGladney
- Start date
CBLENNIE
True Blue
Who is the carrier that is denying this procedure as routine nail care? Have you checked to see if they have a specific coverage/medical policy for this procedure?
Also, are you using your "T" modifiers to indicate which toenail(s) is being treated. Finally, M79.674 is for the right toes but if you are treating left toes and the medical record indicates there is pain from the ingrown toenail(s) you would use M79.675.
Also, are you using your "T" modifiers to indicate which toenail(s) is being treated. Finally, M79.674 is for the right toes but if you are treating left toes and the medical record indicates there is pain from the ingrown toenail(s) you would use M79.675.
StephanieGladney
New
Carrier is Allegiance, pt has coverage for the procedure and coverage for routine foot care with podiatry. However, the rep keeps saying it is denied for routine foot care. I can't get a clear answer from ins but I think it may be because its getting listed as routine and the rendering is not podiatry, but just a guess. It is right great toe and I have tried RT but I will try the T5 mod. Thank you!
CBLENNIE
True Blue
What state are you in, I'm not familiar with Allegiance as it is not a payer in our area of the country that I'm aware of.
It is helpful to have the location you are coding for listed on your profile as most of us will try and research your questions based on the payers in your state/region. If you are in a part of the country where there are multiple MACs for your Medicare population it is particularly helpful for you to list city & state but listing at least the state will get you more responses to your questions because we have a specific area to search for. Many will not bother to respond to your post if there isn't a way to determine who your payer(s) might be.
It is helpful to have the location you are coding for listed on your profile as most of us will try and research your questions based on the payers in your state/region. If you are in a part of the country where there are multiple MACs for your Medicare population it is particularly helpful for you to list city & state but listing at least the state will get you more responses to your questions because we have a specific area to search for. Many will not bother to respond to your post if there isn't a way to determine who your payer(s) might be.
StephanieGladney
New
This is good to know thank you. I'm billing in Idaho. Allegiance is a TPA, it's wholly-owned subsidiary of Cigna using Cigna network. Ill go in an fill out more on my profile. I appreciate your advice. 