Sunday, October 6, 2024

Denial of custom shoes.

Paula Martinek

Hello all and thanks to those who have replied. The census is that 1. we need to use KX modifers. We did not do that in this case. 2. It is often denied if the patient does not have foot deformities, in which case they may reimburse for A5500. 3. We may get reimbursed faster if we submit CMN, RX, and practititioner’s notes with documentation that the patient is being treated for diabetes and related disorders. We may have to call the physician and request copies of their documentation of the diabetic treatment course if the claim is still denied. We have to use the correct ICD-9 with diabetes being 1. and related disorders being 2, and so on. The patient may have gotten shoes within the past year but I do not think that is the case here. I appreciate the help. Paula Martinek, LPO

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