Podiatry Coding & Billing Alert

Question: An established patient came in for a visit and had debridement done on his toe nails (more than six). The podiatrist then cut corn and calluses on four toes and also performed skin partial thickness debridement on both feet. How should I code this visit? Should I use a bilateral modifier for debridement?

Arkansas Subscriber

Answer: You should first report the office with an appropriate E/M code (such as 99213, Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:…). Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to demonstrate that the visit was significantly separate from the procedures performed. For the nail debridement, you should report code 11721 (Debridement of nail[s] by any method[s]; 6 or more). You should attach modifier Q8 (2 Class B findings) to the code to demonstrate the appropriate class findings by the podiatrist. For the corn removal, you may report code 11056 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; 2 to 4 lesions). You should attach ESPU modifier such as XS (Separate structure) with the lesser paying procedure (11721) to differentiate this code from 11056. For the skin debridement, you should bill CPT^® code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) for debridement performed up to subcutaneous tissue level (includes epidermis and dermis, if performed); first 20 sq cm or less. In this case, you should not use a bilateral modifier as that is not applicable.

The correct sequence for coding this report can be:

• 99213-25 -- for E/M
• 11056-Q8 -- Cutting of corn and callus on 4 lesions (nails).
• 11721-Q8-XS -- Debridement of nails by any method; 6 or more.
• 11042 -- Skin debridement

Debridement guidelines: You should report wound debridement by the depth of the tissue the podiatrist removes and by the surface area of the wound. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth but do not combine sum from different depths. In this case, you can bill 11042 for debridement performed up to subcutaneous level with total debridement area of 20 sq cm or less. If the debridement area is more than 20 sq cm for bilateral feet, then you can use add on code +11045 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; each additional 20 sq cm, or part thereof [List separately in addition to code for primary procedure]) for each additional 20 sq cm.