Wiki 11056 Not paying with Medicare WV?

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Does anyone know why code 11056 lesion removal is not being paid with Medicare WV? It will pay for a couple of Medicare replacement plans but not with medicare itself. When I bill the 11056 code it is usually with the regular 11721 for routine diabetic nail care... any help would be appreciated. Thank you.
 
In my neck of the woods, 11721 would need a modifier 59 and 11056 would need a dx of 700, 701.1 or 757.39 plus a secondary dx of 686.9 or 729.5.

This is per LCD 24374 which may or may not apply to your area.
 
Thank you for responding. --We do use that modifier 59 for 11721 and 701.1 with 729.5 with the 11056 but its still not paying.. any other thoughts??
 
We have since switched to using Q7, Q8, or Q9 modifiers... but still getting denials with those modifiers and using 701.1, 443.9, 250.xx or 729.5 as the diagnosis codes. The denial reads:
CO_16 Contractual Obligation - Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
With this denial for all of the 11056 codes in which Medicare is the primary insurance.
 
Rfc

I am having the same problem. (mostly with Dx code 700). I code it exactly like I'm supposed, correct Dx codes, with primary and secondary codes in correct order, Q modifier. 59 modifier, date last seen by PCP, along with PCP's NPI, everything, and it still gets denied as not medically necessary. So frustrating!
 
FINALLY GOT THE 11056 CODE TO PAY!!!!! *JUMP FOR JOY*

To get the 11056 code to pay i had to put a XS modifier on the 11721 and the Q8 or Q9 modifier next to 11056 as well as the patients PCP on the referring provider AND the supervising provider. Hope this helps to anyone else who has had the nightmare of this code not paying.
 
11055

what if you're only needing to code for 11055/11056 as the doctor only removed a painful corn (no nail trimming done)? What if there's not enough cause to add a Q modifier and the only Dx codes you have are 700 and 729.5?? Do you just not bill it?
 
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