Wiki 11750 multiple toes

[tgutierrez]

I have a denial from a commercial payer for CPT code 11750. We billed two of these codes as they were done on the two great toes on one patient. We of course appended TA modifier to one and T5 to the other but the insurance denied one of them stating it was inclusive in the other. Reviewing the code, it does not specifically state 'each digit' or multiple digits either.

In my opinion it should be each nail but my opinion and $5 would buy you a latte.

Does anyone else know the specifics of this code?

Thanks in advance for the help.

 

[mbort]

add the 59 modifier to the 2nd line to let the carrier know it is a "different site".

 

[tgutierrez]

Thank you for the response.

Wouldn't the TA and T5 modifiers explain that it was different sites?

I'm not against adding the 59 modifier but it seems unnecessary and redundant does it? But then again, whatever it takes to make the insurances understand is what we have to do I suppose.

Thanks again.

 

[mbort]

yes the T codes do, however even with Medicare on hammertoes, you have to do the 59 as well. I dunno why, but thats what they want. I have found that many carriers do not recognize the T and F modifiers.