# Toe nail debridement and callous removal



## KimAS

Per CCI edits, we can bill 11055 and 11721 together, as long as we put a 59 modifier on 11721. Caresource is now denying this-saying mutually exclusive. Not sure where they are getting their information. Has anyone else been getting this denial?


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## Lamon Willis

*Modifier -59*

Assuming there is medical necessity for both procedures, modifier -59 is acceptable per current quarter NCCI edits.  CMS guidelines provides the following information related to this similar topic:

"EXAMPLES OF MODIFIER -59 USAGE 
Example: Column 1 Code/Column 2 Code 11055/11720

CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion CPT Code 11720 – Debridement of nail(s) by any  
method(s); one to five

Policy:  Mutually exclusive procedures 

Modifier -59 is: 

1) Only appropriate if procedures are performed for lesions anatomically 
separate from one another or if procedures are performed at separate 
patient encounters. 

2) Don't report CPT codes 11055-11057 for removal of hyperkeratotic skin 
adjacent to nails needing debridement."

Reference:  http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf


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