Wiki CPT 11055/11056 & 11720/11721

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KoBee

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Hello - trying to find examples of when it is okay to unbundle these cpt codes. Anyone have good examples of when these can be unbundled? I read where hyperkeratotic lesion is located on the same distal phalanx, including the skin over the distal interphalangeal joint then you CANNOT unbundled. IS this true???

Help :/
 
Your are correct, according to the NCCI edits:
NCCI has a procedure to procedure edit with column one CPT code 11055 (paring or cutting of benign hyperkeratotic lesion ...) and column two CPT code 11720 (debridement of nail(s) by any method; 1 to 5). Modifier 59 shall not be used to bypass the edit if these two procedures are performed on the same distal phalanx including the skin overlying the distal interphalangeal joint.
 
in order to unbundle, could do 11720 of right foot 1st distal phalanx and 11055 of right foot 1st middle or proximal phalanx?

same location just different part of phalanx, correct?
 
bostonmom said:
Your are correct, according to the NCCI edits:
NCCI has a procedure to procedure edit with column one CPT code 11055 (paring or cutting of benign hyperkeratotic lesion ...) and column two CPT code 11720 (debridement of nail(s) by any method; 1 to 5). Modifier 59 shall not be used to bypass the edit if these two procedures are performed on the same distal phalanx including the skin overlying the distal interphalangeal joint.
Click to expand...


in order to unbundle, could do 11720 of right foot 1st distal phalanx and 11055 of right foot 1st middle or proximal phalanx?

same location just different part of phalanx, correct?
 
bostonmom said:
Your are correct, according to the NCCI edits:
NCCI has a procedure to procedure edit with column one CPT code 11055 (paring or cutting of benign hyperkeratotic lesion ...) and column two CPT code 11720 (debridement of nail(s) by any method; 1 to 5). Modifier 59 shall not be used to bypass the edit if these two procedures are performed on the same distal phalanx including the skin overlying the distal interphalangeal joint.
Click to expand...


or must be on different nails and toes to unbundle?
 
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