Wiki CPT Code 11721

[phillyfan536]

We are billing a cpt code of 11721 with a Q9 modifier for medicare. We are using the following diagnosis code 250.60, 357.2, 110.1

We are not getting paid by medicare for these services. We also are making sure we put the Endocriologist NPI number or the Family Physician NPI number & the last date seen.


Is anyone else having this problem or anyone have any suggestions


thanks

 

[mitchellde]

Does the documentation support the nail fungus code? I only ask as I have run across thru audit a fair number of podiatry claims using the 110.1 code with no documentation of the mycosis. Can you give the documentation of the diagnosis for one of these?

 

[kvangoor]

What is the rejection you are getting?

 

[Jana Lee]

Are you coding 110.1 as the primary diagnosis? If not this could be the problem.

 

[Shay2025]

make sure you include the date in box 15

 

[Evelyn Kim]

make sure to review the LCD for 11721 it has all the information needed. 110.1 should be primary if the documentation supprorts this dx. Also make sure to use 11720 if only 1-5 nails are done and 11721 if 6-10 are done. Getting these paid can be difficult, but follwoing the LCD should help make it smoother.