Urgent Medicare News Bulletin for Routine Foot Care Claims – Apr 10, 2018

TO: TPMA MEMBERSHIP

FROM: GARY W. COCKRELL, DPM
TPMA CARRIER ADVISORY REPRESENTATIVE (CAC)

DATE: APRIL 10, 2018

The following is an update that I recently received from Palmetto’s Carrier Medical Director regarding their response on the numerous claim denials for Routine Foot Care services:

“Issue Identified 3/26/2018 “

It has been determined a Routine Foot Care service edit, based on the Routine Foot Care Local Coverage Determination ( LCD ), L37643, has been editing incorrectly and only allowing one CPT/ HPCPS code identified in the LCD per patient, per claim. This issue affects claims for dates of service on or after February 26, 2018.

The editing will be updated to reflect the LCD’s intent, which is to allow any medically necessary routine foot care services for a given patient once within a 60 - day period. Providers must bill all routine foot care services for a 60 – day period together on one claim for one date of service. The CMS Mutually Exclusive Edits to prevent improper payment when incorrect code combinations are reported will continue to apply to each date of service billed.

 “Provider Action “

3/30/2018: THERE IS NO PROVIDER ACTION. This CPIL will be updated once the editing has been updated and Palmetto GBA will perform adjustments on affected claims.

No specific time line or date was mentioned for the updating and claim adjustments to occur.  However, we would expect this to be resolved within a reasonable period, perhaps by May 1, 2018, if not sooner. Again, there is no need for you to resubmit these denied claims, as these will be corrected internally by Palmetto’s Part B Claims Department. Keep in mind, this adjustment ONLY applies to the claims edit issue, so if a provider’s office improperly submitted a Routine Foot Care claim , with incorrect ICD – 10 codes or incorrect CPT coding pairs or sequences, or incorrect use of modifiers, then these claims could be rejected.