Primary Care Coding Alert

Question: If our FP performed trimming and debridement of nails for a patient suffering from diabetes mellitus, can both the procedures be reported on the same calendar date of service? If so, should we report either of the codes with any modifiers?

Texas Subscriber

Answer: When your clinician performs trimming of nails, you report it with 11719 (Trimming of nondystrophic nails, any number) and you report 11720 (Debridement of nail[s] by any method[s]; 1 to 5) or 11721 (…6 or more) for debridement of nails depending on the number of nails your clinician treated. You can report both trimming and debridement for the same patient on the same calendar date of service, but you will need to append an appropriate modifier.

You will face bundling according to Correct Coding Initiative (CCI) edits if you try reporting trimming and debridement codes for a patient on the same calendar date of service. As the modifier indicator for these edit bundles is ‘1,’ you can overcome the edit by appending an appropriate modifier to the column 2 code.

If reporting debridement (11720 or 11721) in addition to 11719, the debridement code is the column 2 code, so you will have to append the modifier to this code in this situation. However, if reporting debridement in addition to G0127 (Trimming of dystrophic nails, any number), the G0127 code is the column 2 code and requires the modifier.

You will have to append the modifier 59 (Distinct procedural service) to the column 2 code, and you will need to mention in the documentation that your clinician performed the procedures on different nails for the same patient on the same calendar date of service.

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