Primary Care Coding Alert

Check carrier frequency limitations for 11720 and 11721 If you can count on a denial for -routine foot care- every time you report CPT 11720 -CPT 11721 for Medicare patients, this article is for you. Many carriers actually cover debridement -- if you know the ropes.
 
Use the information in the article below to help avoid denials and recoup your rightful payment. 1. Identify the Acceptable Procedure and Diagnosis Codes The following three different procedure codes represent mycotic nail debridement: 

- 11720 -- Debridement of nail(s) by any method(s);  one to five

- 11721 -- Debridement of nail(s) by any method(s); six 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. Among many carriers- diagnosis requirements for debridement coverage is the presence of a systemic condition causing mycotic nail(s).

For example, you can get paid for mycotic nail debridement when systemic conditions such as metabolic, neurological or peripheral vascular diseases result in severe circulatory problems in the legs and feet, according to an article from Cahaba Government Benefit Administrators, a Part B carrier in Georgia.

Most carriers will also pay without a systemic condition present, such as Blue Cross and Blue Shield of Arkansas. However, this carrier's Local Coverage Determination (LCD) requires clinical evidence of the mycosis plus documentation that the patient has pain or -secondary infection resulting from the thickening and dystrophy of the infected toenail plate.- In addition, ambulatory patients must have documentation of impaired walking.

Helpful: Most LCDs include a list of acceptable ICD-9 codes that will justify debridement of mycotic nails, and usually LCDs require a primary diagnosis of 110.1 (Dermatophytosis of nail) and a secondary diagnosis, such as 729.5 (Pain in limb).

The key is having a reliable method for keeping these carriers- individual debridement requirements straight.

-According to Medicare guidelines, we report 11721 with diagnosis codes 110.1 and 729.5 if the patient has pain,- says Angela Pietrangelo, billing manager with BILLPro Management Systems Inc.

If the patient has no pain, Pietrangelo reports 11721 with 110.1, along with a diagnosis code that represents an accompanying systemic condition. -We also include the date that the patient was last seen by the PCP, which must be within the [...]