One time per lifetime Matrixectomy for Medicare

[Dermato Fight Club]

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Have you guys had these denials yet? I guess this is somewhat new? I just received my first denial on a new patient who had an ingrown nail and I performed a partial matrixectomy on (11750). Denial states they only provide payment for one procedure per lifetime per nail and the patient already had that procedure performed on that toenail 3 years previously.

Have you guys seen this? How do we possibly combat this?

 

[Weirdy]

Have you guys had these denials yet? I guess this is somewhat new? I just received my first denial on a new patient who had an ingrown nail and I performed a partial matrixectomy on (11750). Denial states they only provide payment for one procedure per lifetime per nail and the patient already had that procedure performed on that toenail 3 years previously.

Have you guys seen this? How do we possibly combat this?

Havn't had it yet.
Will keep a lookout.

 

[heybrother]

1. Yeah, I've had it. Its terrible. When they initially put it in they were denying bilateral procedures. There's also something very funny about screwing the doctor who is revising someone else's botch.
2. Unless something has changed you can overcome it in even the post-payment appeals process with a KX modifier and a detailed description of why the procedure needed to be performed ie. different nail, different border, etc.
3. I looked back at some of my denials on new patients and yeah - no history related of prior nail surgery.
4. My memory is there is technically some sort of ABN type process that you can have patients sign that allows you to transfer the liability to the patient. The idea that the liability should initially be transfered to us is just very frustrating.
5. The Medicare coded note that they provide on these is really difficult to follow for lay people. My staff didn't understand it and I only knew about it because I had followed the "news" when it first started. Another example of a Medicare note that is unclear to my front desk is the MUE type note. They don't know what to make of it.

 

[Dermato Fight Club]

1. Yeah, I've had it. Its terrible. When they initially put it in they were denying bilateral procedures. There's also something very funny about screwing the doctor who is revising someone else's botch.
2. Unless something has changed you can overcome it in even the post-payment appeals process with a KX modifier and a detailed description of why the procedure needed to be performed ie. different nail, different border, etc.
3. I looked back at some of my denials on new patients and yeah - no history related of prior nail surgery.
4. My memory is there is technically some sort of ABN type process that you can have patients sign that allows you to transfer the liability to the patient. The idea that the liability should initially be transfered to us is just very frustrating.
5. The Medicare coded note that they provide on these is really difficult to follow for lay people. My staff didn't understand it and I only knew about it because I had followed the "news" when it first started. Another example of a Medicare note that is unclear to my front desk is the MUE type note. They don't know what to make of it.

Yes. I can have my patient sign an ABN and they are responsible to pay for the procedure. So maybe I get the money from the patient but they will not happy and are much more likely to write a review about me than a letter to their congressman.

 

[heybrother]

Yes. I can have my patient sign an ABN and they are responsible to pay for the procedure. So maybe I get the money from the patient but they will not happy and are much more likely to write a review about me than a letter to their congressman.

Correct. Medicare patients don't ever believe they owe anything. The reason I bring it up is because all of my historic denials have had a whole bunch of text about ABNs attached to them, but I fully concede that it is a disaster. Also you won’t know to have the patient fill out an ABN unless they relate a history nail surgery and they often won't tell you. And you aren't supposed to blanket ABN. That said - post denial appeal with KX works.

 

[Feli]

You need to use the 77 or 76 and KX mods and document that it was "medically necessary revision of procedure by same/another physician due to recur ingrown."

Even then, what a world. I am much more struggling with the 1105x denials... quite lame.

I had matrix failing left and right when I was in the supergroup that would have big bottle of probably long-expired phenol.
I do nearly all of mine now with 6200 blade to prep the corner, then single-use phenol, but I still get a few recurs.

 

[deleted1235332]

are you guys bringing back the matrixectomy? Prn? <10 days and global or >10 days to get an office visit?

TFP question 🙂

 

[Dermato Fight Club]

are you guys bringing back the matrixectomy? Prn? <10 days and global or >10 days to get an office visit?

TFP question 🙂

The guy I used to work for would bring them back 2 days later then 2 weeks later. So that's how I started doing it but it seemed like a waste of everyone's time. No wonder how he was able to put his kid through podiatry school. I leave them prn and they will call if they need me.

 

[dtrack22]

are you guys bringing back the matrixectomy? Prn? <10 days and global or >10 days to get an office visit?

TFP question 🙂

Offer a 2 week f/u in kids/teens if mom or dad wants me to check it. Will tell new patients who’ve never had a matrixectomy that they can schedule a 2 week f/u if they want me to look at it but give them an expected healing timeline and let them be PRN if they would prefer. Anyone who has had one done before, I tell them that they are PRN and to call for re-eval only if they have concerns.

Never see a 10 day global patient inside of the 10 day global.

 

[Feli]

I put all matrix back in 2-3wks (shorter f/u appt slot unless they have significant other stuff going on).

About 80% doing fine and get PRN at that matrix f/u visit. Some are macerated even though we tell them no soaking post-procedure (TFP... no EBM for it, doesn't make sense).
The other maybe 20% get another appoint after 2-3wk f/u visit (usually that one is ~2mo after initial proc) and/or abx and/or wound debride at the 2-3wk visit.
Probably less than 5% call the office with concern and get Rx for abx or something stronger than OTC acet for pain. (yes, avoid seeing them in office before 10+ days if at all possible)

Basically, everyone's pain tolerance and comfort with procedures is different.
Everyone shows up in different shape to begin with... from badly infected and on abx from PCP/UCare to just minor wide/pincer nail and no infection whatsoever... pain minor to significant... one nail margin up to total nail matrix or maybe bilat bi-border... people wear diff shoes and have diff jobs or sports. So, there is no cookie cutter way to do it.

We make little bag kits with band aids and alc pads and print post-procedure instructions (band aid qd prn, alc cleanse, no soaking, acet OTC prn, etc) given with the procedure.

I will consider PRN (or encourage text or call us and cancel if healing fine) on the procedure day if they've had the same procedure with me before and know what to expect. It's individual... even those can make/keep a couple f/u visits if that's what they want.

 

[Stormblest]

I usually offer a 2 week f/u if it was pretty bad (large paronychia with infection) or if the patient was worried. I try to leave them PRN as much as possible so I can get new patients coming through faster. I just tell them to call with any issues and rarely ever hear back.

 

[Adam Smasher]

are you guys bringing back the matrixectomy? Prn? <10 days and global or >10 days to get an office visit?

TFP question 🙂

Infections happen around POD 3-5, so I learned to handle those over the phone, rx antibiotics. I PRN non-diabetics.

Diabetics almost always benefit from a 2 week post op check to debride the wound, which I bill as a 97597, when appropriate.

 

[dtrack22]

Infections happen around POD 3-5, so I learned to handle those over the phone, rx antibiotics. I PRN non-diabetics.

I should add, I also stress throughout the visit that the procedure will cause redness. It’s a chemical burn. The redness is not infection. Don’t call me 3-4 days later because you think it’s infected. It’s not. I do tell them if that redness or any drainage is worsening along with worsened pain day 5,6,7 that they may call and I’ll Rx abx at that time. But I don’t make them come in, because the heck with antibacterial stewardship, I’m not about to waste a clinic appointment with that when I’m already scheduling new patients out around 5-6 weeks.

 

[deleted1235332]

^ Most useful post on this whole website

 

[Bored Snorlax]

^ Most useful post on this whole website

If this gets memed, my money’s on @air bud

 

[air bud]

Every ingrown nail should be PRN..... If you're worried about what it's going to look like in two weeks you shouldn't be doing it. It's about new patients. Not wasting that slot.

 

[Hybrocure]

^ Most useful post on this whole website

I’m dying.

 

[deleted1235332]

Every ingrown nail should be PRN..... If you're worried about what it's going to look like in two weeks you shouldn't be doing it. It's about new patients. Not wasting that slot.

A lot of people like confirmation I feel like every patient I see is always like “are you sure it looks good” and then they’re relieved.

 

[Sendin_Toes_2market]

My hospital urgent care was billing Slantbacks as 11750, as those dates aligned when patient went to our hospital owned urgent care. I had 3-4 complain. My hospital was complaining about audits. I told them I am not changing billing. Did message the urgent care about fraud. Who do the patients blame? The people who do it right lol. They ended up paying cash and leaving a negative review on the hospital thankfully left my name out of it.

They are still doing this btw.

 

[Bluecollarmed]

Our urgent care and hospital ED providers have said they are a little more "barbaric" and prefer to just send ingrowns to me without touching them. Still put the ones who need it on abx though. In fairness it takes less time for their encounters and patient's realistically get a better treatment coming to clinic to have it done. Win-win.

 

[Feli]

Our urgent care and hospital ED providers have said they are a little more "barbaric" and prefer to just send ingrowns to me without touching them. Still put the ones who need it on abx though. In fairness it takes less time for their encounters and patient's realistically get a better treatment coming to clinic to have it done. Win-win.

Yep, this is the way it should be... abx (or not) and turf ingrowns, verruca, heel pain, whatever.

I find that's the way probably 90% of ER and 80% of PCPs roll. My local ER docs tend to do total nail avulsoins on the highly infected (abscessed) ones. It essentially comes down to reimburse: the ER docs on salary (hourly) will just send, and the UCare that are reimbursed on procedures like to do more.

The PCPs tend to do little or noting... but a few will do heel inject 3x or PT for ankle sprain or try a little wound care or an ingrown procedure or Rx ciclopirox or terbinafine PO before sending the refer. The smart ones have figured out that wart treaments or heel injects are fast and easy and profitable, but most are too busy or just not interested. Again, depends if they are mostly on salary or more/pure collections-based.

Interestingly, that proportion of PCPs who will try basic treatments will increase significantly for the collections-based offices if there is any type of economic downturn or the doc/provider is just new and slow schedule. For covid years, many PCPs were doing a lot more as office patients were much harder to come by for a little while. Maybe they wanted the collections, and maybe they wanted to help the patients without another specialist visit (99% chance of the latter). It's always a 'follow the money' thing at the end of the day.