Microsoft PowerPoint - 2006 MI Great Lakes Podiatric Conf 031006

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					Foot Care
Presented by: Lydia Bean Ellen Berra Provider Outreach and Education WPS Medicare March 10, 2006

Covered Foot Care
Medicare pays for services that are provided within the scope of practice for a particular provider. The WPS Medicare rules apply regardless of the specialty of the provider performing the service. Documentation is the key to determining Medicare coverage.
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Covered Foot Care
Medicare does not pay for routine foot care in the absence of a systemic condition sufficient in severity that care by a non-professional would be harmful to the patient.

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Mycotic Nail Care
In the absence of a systemic condition, treatment of mycotic nails may be covered. Documentation would show
• clinical evidence of mycosis of the toenail • patient has marked limitation of ambulation, pain or secondary infection.

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Mycotic Nail Care
Nail Debridement is a surgical procedure to remove all the diseased nail body/plate and debris of the infected nail bed. Simple trimming of the free ends of the nails by cutting or grinding is not considered debridement. Procedure codes 11720 and 11721 do not represent right and left. 11720 is 5 nails or less; 11721 is 6 or more nails.
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Evaluation and Management Services
Medicare has several National Coverage Provisions (NCP) concerning Evaluation and Management (E&M) Services. These policies should be checked to determine that the provider is using the E&M codes and modifiers appropriately.
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Evaluation and Management Services
PHYS - 001, General Coverage for Physician Services, discusses the following: PHYS – 004, Incident to a Physician’s Professional Service PHYS – 006 Consultations PHYS – 068 Coverage of Services in Nursing Facilities

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Evaluation and Management Services
E&M services provided on the same date as a surgical code are included in the surgery. See GSURG-001 for exceptions. Do not bill an E&M service unless it meets one of the published exceptions. Modifier 24 is for unrelated E&M during the post-operative period. Modifier 25 is for significant, separately identifiable E&M on the same day as a procedure.
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Limitation of Liability
Medicare pays for services that are medically necessary. They must be
• Reasonable and necessary, and • Safe and effective

While the category of service may be covered, in certain circumstances, it may not be considered reasonable and necessary under Medicare.
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Limitation of Liability
A provider is expected to know Medicare’s payment rules and regulations. If the provider is aware that Medicare will not cover a particular service for a particular patient based on medical necessity, then an Advanced Beneficiary Notice (ABN) should be given to the patient.

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Importance of Documentation Medical Records must be:
Complete Pre-existing Legible

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Importance of Documentation
• Confirms billed procedure was performed. • Substantiates service was billed with appropriate code. • Promotes continuity of care with other healthcare professionals. • Records pertinent facts, findings and observations of patient’s condition.
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Checking Documentation
Some questions to ask yourself Legible? Proper sequence of events? Necessary additional documents included? Initialed/signed and dated? Abbreviations standard or defined? Stands on its own?

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When you fill out your evaluations please let us know if you have any other ideas to improve our service to you. Thank You For Your Time !

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