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Knowing the Novitas policy not sure about the other MACs, but this is taking right out if the current active LCD • Repeat use of surgical preparation services in conjunction with skin substitute application codes will be considered not reasonable and necessary. It is expected that each wound will require the use of appropriate wound preparation code at least once at initiation of care prior to placement of the skin substitute graft, So, at least Novitas expects it on first graft only.

ESWT for Novitas Medicare who covers the State of NJ does not cover ESWT (Extracorporeal Shock Wave Therapy) for various musculoskeletal conditions, including plantar fasciitis. This is because Medicare considers ESWT experimental or investigational and insufficient evidence of its effectiveness has been established. So, its is a cash service.

The question is intended for palliative debridement/pairing only. The hyperkeratotic skin and nuclei were reduced with a #15 blade. No biopsy or local anesthesia was needed. This would be the same treatment as a callus debridement/pairing. My concern was that 11055 was exclusive to callus.

Dave, your response left me confused. The first part of your post indicated 11055 was not appropriate and last part recommended 11055 as the appropriate code. Palliative care coding is so much fun.

Dear Sarah, we do audits as a consultant as does my partners in thedoctorline.com . Audits are either targeted or random and we can select various aspects in a practice to review. A consulting agreement is made with one of us. My consulting email is djfreedman@cpmapro.com. Dr. Bass email is alan@parecomplianceservices.com Dr. Kesselman email is paul@parecomplianceservices.com.

This patient undoubtedly qualifies for several reasons, but one should check your LCD to be sure which your MAC may see the best fit: 1) The patient even has vascular class findings of Q8. Hence h/she qualifies under vascular qualifications and you can be the treating/referring doctor. Your date of last at risk foot care or the last date you saw them (whichever is more recent) will work as the DLS. Where things get tricky is if the patient has had a revascularization and now has pulses but they may still have other class findings (Q9). Aren't these patients still vascularly compromised? Since we are supposed to use the highest level of coding, one should however use the DM I or II code which covers the DM diagnosis with vascular findings. Using this scenario, the MD/DO treating the DM is the referring provider and one needs to obtain their DLS. 2) The patient may qualify under neurologic findings as related to his DM or even due to his/her previous renal issues. In both of these scenarios the treating MD/DO would need to be listed as the referring entity along with the DLS. The neuropathic diagnosis would need to come from the treating MD/DO. 3) Accoriding to recent communications with the American Endocrinology Association, and a Dr. Google search, a patient with a pancreas transplant who was diabetic is still considered diabetic, though normo glycemic. Think of it as the same as a patient whose BS and A1C are normal and stable due to pharmacological intervention. They are now DM II, perhaps even though they were DM I. Again, which category they are placed in depends on how the MD/DO managing the DM diagnosis them, but largely is now based on are they normo glycemic without meds or are they still on Insulin, but a lower dose than before? In communicating with the endocrinologists who continue to manage these patientspost transplantation, the patients neuropathy and vascular disease complications have not magically disappeared with pancreas/kidney transplantation. Those complications are still with the patien and will be for life. Even if their symptoms are controlled or minimized with neuropathic controlling agents don't they stil have neuropathy? For those reasons, all the MD/DO I have spoken with over the years have always considered pancreasd transplant patients diabetic and have had no issues with not only referring them for continued at risk care but also certifying the patients as DM for therapeutic shoes. If one checks the literature, most, not all, will cite pancreas transplants as treating DM not curing it.