10/06/2022

Healthfirst Denial for 11721 with dx B35.1 and I79.8

Question about healthfirst If someone has B35.1 as the primary diagnosis and I79.8 as the secondary diagnosis, why should 11721 deny with the explanation procedure not valid with diagnosis please keep my name confidential

The denial from Health First is not valid and should be appealed. The Medicare Advantage plan follows the coding article on routine foot care for determining what codes are medically necessary for routine foot care services. As of the current document from the Medicare contractor, I79.8 is a valid secondary diagnosis to report as a systemic condition that should be reimbursed by Health First. When following the appeals protocol, be sure to include a copy of the Medicare policy (see link below) that confirms that the billed diagnosis is covered per Medicare.

Article - Billing and Coding: Routine Foot Care and Debridement of Nails (A57759) (cms.gov)