Friday, May 24, 2024

M Fingers & Insurance

Kelsey Holden

Hi everyone,
A colleague of mine and I are working with a partial finger amputee. He is missing 3 digits. We coded out for the M Fingers and some codes were denied while others were approved. The denied codes were 7400, 7403 and 6687. “The procedure is not payable based on the BCN Complete (Medicaid) fee schedule. The approved codes were 6680, 6687, 6695, 6696 and 7499. I reached out to the patient to let him know. He then told me that he now has Medicare as well.

1. Before we resubmit the claim to medicare, do you recommend coding just as 1 miscellaneous code? What has worked best for you?
2. Let’s say he didn’t just tell me he now as Medicare, how would you proceed? Patient asked about a cash price so I was going to figure out what price I would offer him.
3. Is there an Upper Limb Prostheses LCD like there is for lower limb?

If someone is willing to chat with me I can happily provide pics of the hand for some more insight as well as the insurance denial.

Thank you!

Kelsey Holden, CP
ABC Certified Prosthetist
Befitting You Medical Supply
C: (248) 891-8345
F: (855) 350-5612

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