02/24/2020

Target and Educate Audits, ABN and 11719 vs G0127

I am currently being audited by Medicare (Target and Educate). Do I need to obtain Advanced Beneficiary Notices for the patients or is it only if I feel the service will not be covered. Also I have been using 11719 for trimming of dystrophic nails instead of g0127 Will this be a major problem. Have since rectified the problem. Thanks

Medicare frequently does the Target and Educate audits.  It is important to keep a record of when you realized and made the change for the misuse of the code.  Medicare takes that into consideration when you have fixed a problem and are therefore, lenient with their audits.  What Medicare may do is recoup the 11719 and pay the G0127 or vice versa. Going forward make sure to use the appropriate CPT whether its dystrophic or non-dystrophic.

11719

Trimming of nondystrophic nails, any number

G0127

Trimming of dystrophic nails, any number

See link below for the RFC LCD policy:

Lcd L33636 Rfc And Debridement Of Nails

As for the ABN, it is good practice when seeing a new patient, office, nursing home or house call to have an ABN signed. The reason is that they may have been treated by another provider within the allotted days.This at least covers you and allows you to bill the patient under patient responsibility.