Podiatry Coding & Billing Alert

Question: I am coding for debridement of mycotic nails using CPT 11720 or CPT 11721 . Why does Medicare continuously deny my claims?

Massachusetts Subscriber

Answer: Don't fret. Many carriers do cover debridement. You just have to take note of some important details. First, you should keep in mind your three coding choices:

• 11720 -- Debridement of nail(s) by any method(s); one to five
• 11721 -- ...6 or more
• G0247 -- Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include the local care of superficial wounds (i.e., superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails.

CPTs 11720-11721 are applicable if the patient has an infection and pain during ambulation. Among many carriers' diagnosis requirements for debridement coverage is the presence of a systemic condition (such as such as metabolic, neurological, or peripheral vascular diseases) causing potential risk if the patient performed the debridement himself.

Catch: Stop reimbursing for nail care once your patient's mycotic symptoms lessen if you don't want to be in trouble. TrailBlazer's policy continues with, "The treatment of mycotic nails in the absence of a qualifying covered systemic condition will not be covered after the acute symptoms caused by mycosis have abated."

-- Answers to You Be the Coder and Reader Questions were reviewed by Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.