Podiatry Coding & Billing Alert

Question: I am getting denied for CPT 11721 with a diagnosis of 110.1. Is it because I am not using a Q modifier?

Texas Subscriber

Answer: When billing Medicare, a mycotic nail debridement code -- 11720 (Debridement of nails[s] by any method [s]; 1 to 5) or 11721 (Debridement of nails[s] by any method [s]; 6 or more) that uses a secondary systemic diagnosis code such as 110.1 (Dermatophytopsis, of nail) you must include a class findings modifier (Q7, Q8 or Q9). You must also report the name of the patient's primary care physician (PCP) and the date last seen (DLS) by the PCP.The DLS should be within six months of your date of service.