# 99214 & 11055



## LNader (Oct 10, 2016)

Help please!! I have a claim which the doctor performed a level 4 exam with paring of callus. I used a modifer 25 on the E/M and a modifer XU on the paring. It is still being rejected. So, what modifers should be used, if any. Thank you in advance.


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## danskangel313 (Oct 10, 2016)

LNader said:


> Help please!! I have a claim which the doctor performed a level 4 exam with paring of callus. I used a modifer 25 on the E/M and a modifer XU on the paring. It is still being rejected. So, what modifers should be used, if any. Thank you in advance.



You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?


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## LNader (Oct 11, 2016)

danskangel313 said:


> You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?



Originally I did code it that way and it was denied stating it lacked information or billing error. There is nothing in the submission ie: missing information so I figured it was a coding error. I do not have the energy to tackle the dreaded phone tree  unless absolutely necessary.


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## ollielooya (Oct 11, 2016)

*more info needed?*



danskangel313 said:


> You shouldn't need a modifier on the paring. Did you try billing the E/M with the 25 and the paring with no mod?



Did the office visit warrant the assignment of a level four?  What are the diagnoses? And what are you thoughts behind adding modifier XU?  Just curious....


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## danskangel313 (Oct 11, 2016)

My guess is it's a DX issue.


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## NikkiBrownell (Oct 16, 2016)

*Medical records?  reas*

I am a biller and I would suggest doing an appeal with medical records that document the reason the parring was done. I agree the original coding with the 25 modifier on the office visit is what I would have done.


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## espressoguy (Oct 17, 2016)

I agree with danskangel in that it is more than likely a diagnosis issue. 11055 is considered routine foot care and some insurance does not cover routine foot care. For example, Medicare only covers 11055 with specific diagnoses.


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