Nail Debridement Audits Have Begun

Medicare has started mailing records requests to review claims with both an office visit and a nail debridement. So far, we have seen June and July dates of service picked for review. As stated in our June 11th posting, Medi- care policy dictates that visits should only be reported with a debridement if the provider is evaluating a separate issue. Any visits billed only with debridement payable diagnosis codes such as 110.1 and 729.5 are likely subject to denial and further audits. If billing both services, make sure your notes and diagnosis codes clearly indicate the separate issues.

Be on the lookout for these request letters, labeled “CMS” on the top left. Before submitting them to HCA, please review your notes to ensure compliance and attach them to the letter so we can forward the documentation to Medicare. Any submitted documents require a legible signature or initials from the provider. Medicare will ac- cept electronic signatures as well. HCA will submit the documentation once received and review any unwarrant- ed denials that may result from the review.