SNF billing question

SNF billing question

Tracy Fields

2/25/2022

Question??

I have a prosthetic claim that paid 1/2 and denied the other 1/2 to which
this makes no sense to me but I am hoping you may have an idea. Insurance
is Medicare. I have spoken with customer service and of course they will
not offer up much assistance aside from confirming all codes and possibly
refiling the claim, which I have and it continues to deny.

This patient is a permanent resident at a SNF and has been there for over a
year without any discharges. I billed for a preparatory prosthesis and
indicated the place of service as 31 with the facilities information for
where it was delivered at. I have done this several times before and this
has never happened. I cannot say for certain if the others had been there
that long or not.

The claim came back and paid for the foot and liners but denied the whole
first half of my claim that had the base code and addition codes indicating
that the procedure or service is inconsistent with the patient's history.

I have scrubbed this claim back and forth and everything I see is correct.
ICD 10 codes are properly indicated; the Dx code is Z89.512 LBKA. My
modifiers are accurate as well. I confirmed all codes are BK codes as they
should be.

The only thing I can think of or am questioning is if since he has been
there long beyond the 100 days and is a permanent resident, should I have
billed POS 12 instead? This confuses me because they paid the whole other
half of the claim with all the same coding information.

Any advice or direction you may have would be so greatly appreciated. Hope
you all have a great weekend.


Thank you


*Tracy Fields*
Billing Specialist

*First Step Prosthetics*

*Kentucky Location:*

1136 US 31W Bypass, Bowling Green, KY 42101
Phone 270.904.6130 / Fax 270.721.0749

*Tennessee Location:*

179 Hancock Street, Gallatin, TN 37066
Phone 615.461.8557 / Fax 615.461.8581

Email: <Email Address Redacted>


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