Podiatry Coding & Billing Alert

Question: When we see a patient for CPT 11055 and/or CPT 11720, do we include the last date the patient says he saw his primary care physician in Box 19 of the CMS form?

Pennsylvania Subscriber

Answer: Services such as 11055 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion) and 11720 (Debridement of nail[s] by any method[s]; 1 to 5) are often included with more extensive care, but you can sometimes report them separately. If, for example, the patient is undergoing treatment for diabetes, peripheral neuropathies involving the feet, or certain other conditions, that condition might justify coverage for routine foot care.

When that's the case, some carriers require you to include the primary care physician's NPI number and the date last seen in Box 19 for some conditions. Check your carrier's LCD (Local Coverage Determination) for conditions requiring the additional documentation.

Keep in mind: There is nothing wrong with adding the primary care physician's information in other instances -- you won't receive a denial for including it. It can be difficult, however, to obtain the date last seen so many coders opt to only obtain it when required.