07/28/2023

Wellcare Denial-11721

After months of trying to deal with Wellcare's continued denial of 11721 for diabetic patients telling me it's not covered... they now are telling me I must use the multiple surgery modifiers instead of 59... Can you clarify?

If one routine foot care procedure code is billed with an E&M code and no other services, modifier -51 should not be required. The multiple surgeries modifier is only requested at a payer level of two or more surgical procedures are billed on the same DOS.

If two routine foot care procedures are performed on the same day, modifier -51 would proceed modifier -59 on the lesser of two procedures.

If the diagnosis linkage between procedures is distinct, correct modifiers were used, and a portion of the claim was denied, it should be appealed with supporting documentation.