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Elizabeth M. Whitehorn, Director

Podiatric claims denying G51, Podiatric Service Inappropriate for Diagnosis

HFS System Issue:

  • Claims for dates of service prior to 10/01/2014 that were billed with a diabetic diagnosis code were denied G51, Podiatric Service Inappropriate for Diagnosis. ***This system issue was fixed December 23, 2014***

  • Claims for date of service on or after 10/01/2014 that were billed with a diagnosis code other than a diabetic diagnosis were denied G51, Podiatric Service Inappropriate for Diagnosis. ***This system issue was fixed November 5, 2014***

Problem:

Senate Bill 0741 lifted the restriction on podiatric services for adults 21 years and older beginning October 1, 2014. Podiatric services are not limited to individuals with diabetes diagnosis on or after October 1, 2014. The programming was not completed on October 1, 2014 and claims denied.

Providers Impacted:

Podiatrists

Procedure Codes Impacted:

All podiatric procedures were potentially affected, depending on claim receipt date.

Problem Begin Date:

Claims received on or after 10/01/2014.

Problem Fix Date:

11/06/2014 for claims with dates of service on/after 10/1/2014

12/23/2014 for claims with dates of service prior to 10/1/2014

Resolution for Impacted Claims:

Providers must re-bill the department. A time override has been systematically authorized for claims to bypass the timely filing requirement if the claims were previously submitted and affected by this issue.

Claims not previously submitted are subject to the timely filing requirement.

*All re-submitted claims, electronic and paper, must be received by the department by 07/26/2015.