Billing and Coding
The simple separation of fingernail or toenail from nail bed, first nail.
What is CPT 11730
These can be two-digit numbers, two characters, or alpha-numeric.
What are modifiers?
The Simple treatment of ingrown toenails (e.g., trimming, cutting, clipping of the distal unattached nail margins.
What is not medically reasonable and necessary?
This is where you check to see if more than one claim was submitted for the same beneficiary.
What is the bene history spreadsheet?
The project identification number
what is 01-121?
The provider is financially liable for the claim.
What is CO (Contractual Obligation)?
The modifier T6 stands for this.
What is right foot, second digit.
When denying a claim for not meeting medical necessity, you should add this after the denial reason.
What is a personalization statement?
A repeat nail avulsion on the same toe or finger following a complete nail avulsion cannot be performed more frequently than this.
What is every 8 months (32 weeks) for toenails or 4 months (16 weeks) for fingernails?
The guide you can use in SMRC processes to help you construct your narrative.
What is the Narrative Construction Guide & Reference Information?
The denial code used when the documentation does not support medical necessity per the LCD.
What is GBC01?
Social Security Act (SSA) Title XVIII, Section 1862(a)(1)(A), is the reference used to support this.
What is Medical Necessity?
This is used for each specific jurisdiction to determine if the service was reasonable and necessary.
What are the LCDs?
The decision you use when you correct code a claim.
What is partial approved?
This modifier should not be appended to an Evaluation and Management (E/M) code.
What is modifier 59?
A written notice from Medicare, notifying the Bene, Medicare may deny payment for the provided service.
What is an ABN (Advance Beneficiary Notice of Noncoverage)?
A disorder of nail plate growth that is clinically characterized by an opaque, yellow-brown thickening of the nail plate with associated gross hyperkeratosis, elongation, and increased curvature.
What is Onychogryphosis.
You should do this if you are unsure if the documentation supports medical necessity.
What is submit a consult?
History and Physical, a detailed description of the pre-op findings, and an operative report are this.
What is documentation to support Nail Avulsion and E/M services?
The appropriate financial liability for: Patient Responsibility.
What is PR?
Significant, separately identifiable E/M service by the same physician or other qualified health care professional on the same day of the procedure.
What is the 25 modifier?
This is the surgical procedure that involves the separation and a partial removal of a border of the nail plate.
What is Nail Avulsion?
This is symptomatic onychocryptosis (ingrown fingernails or toenails.
What is a covered indication for Nail Avulsion?
Subungual and periungual tumors, Nail debridement, Ingrown fingernails or toenails, and Psoriasis of the fingernail or toenail are all medically necessary according to this.
What is LCD specific coverage guidance?
SMRC operations SharePoint page, Project Resources.
What is where I find the Review Guide, Worksheet and LCD resources?