Podiatry Coding & Billing Alert

Question: I heard that when billing CPT 11721, diagnosis code 110.1 needs to be the primary diagnosis code. When billing CPT 11055, the primary diagnosis code should be 700. Assuming the patient has a systemic diagnosis as well, how do you bill both procedure codes on the same claim for same date of service?

New York Subscriber

Answer: Assuming you are billing for outpatient provider services, you should bill them on the same CMS 1500 form but you should change the diagnosis pointers for each claim line. You can list more than one diagnosis code on the form -- just point the diagnosis to the procedure.

Here's how you should report it: Box 21

• 1. 110.1 (Dermatophytosis of nail)
• 2. 700 (Corns and callosities)
• 3. 443.9 (Peripheral vascular disease, unspecified)

CPT diagnosis pointer

11721 (Debridement of nails, by any method 6 or more) 1, 3

11055 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion) 2, 3

The first line tells you 110.1 is the primary diagnosis for proc 11721. On the second line, 700 is the primary diagnosis for 11055

Reminder: If a diagnosis code is the primary diagnosis code that supports one procedure, we cannot make another diagnosis primary just to get a claim paid. Nor can we put two diagnosis codes as primary to get a claim paid. We all have to follow the rules when it comes to coding and claims submission even if it means the claim will be denied.