1formissy
Guru
I actually work for a payer, and we have a provider who is reporting CPT code 11721 and 11056 on all claims. The modifier -59 is appended to 11721. According to 59 modifier description it says, Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.
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Example 4: Column 1 Code / Column 2 Code - 11055/11720
>CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
>CPT Code 11720 ? Debridement of nail(s) by any method(s); one to five
CPT code 11720 should not be reported and modifier 59 should not be used if a nail is debrided on the same toe from which a hyprkeratotic lesion has been removed. Modifier 59 may be reported with code 11720 if multiple nails are debrided and a corn that is on the same foot and that is not adjacent to a debrided toenail is pared.
Now, if you look at Medicare's Learning Manual regarding Routine Foot care, it says patients are covered for both services, if the patient has a certain diagnosis. On almost all the records I receive from the provider, this is the information that is sent to me.....
"Mr. ##### returns today for routine evaluation and care. The patient has diabetes mellitus with neurological manifestations. Nails are notes to be thickened, dystrophic, friable, positive debris with yellowish discoloration times ten; keratomas of the medial aspect of the IPJ of the first bilateral. Nails and keratomas were reduced and equilibrated without incident??"
Any help on this would be really appreciated.
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Example 4: Column 1 Code / Column 2 Code - 11055/11720
>CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
>CPT Code 11720 ? Debridement of nail(s) by any method(s); one to five
CPT code 11720 should not be reported and modifier 59 should not be used if a nail is debrided on the same toe from which a hyprkeratotic lesion has been removed. Modifier 59 may be reported with code 11720 if multiple nails are debrided and a corn that is on the same foot and that is not adjacent to a debrided toenail is pared.
Now, if you look at Medicare's Learning Manual regarding Routine Foot care, it says patients are covered for both services, if the patient has a certain diagnosis. On almost all the records I receive from the provider, this is the information that is sent to me.....
"Mr. ##### returns today for routine evaluation and care. The patient has diabetes mellitus with neurological manifestations. Nails are notes to be thickened, dystrophic, friable, positive debris with yellowish discoloration times ten; keratomas of the medial aspect of the IPJ of the first bilateral. Nails and keratomas were reduced and equilibrated without incident??"
Any help on this would be really appreciated.