Wiki Help with bilateral CPT 11765

[tosborne]

I have a physician that done a wedge resection on the left and right side of the right great toe. He is wanting to charge a 11765 with a 50 modifier. I think that the 50 modifier should only be used if he done a wedge resection on the right and left great toe. He says that it is considered bilateral if both sides of the same toe have the wedge resection. Could somebody please clarify this? Thanks.

 

[kfantetti]

IIf the physician did a wedge resection on either side of just one toe, here the RT Hallux, I would let the Dr. know that bilateral does not apply here. To get credit for each of the incisions, you could charge 11765.T5 and 11765.T5.59. Hope this helps.

 

[tefranklin57]

•CPT codes 11750 and 11765 apply to one or both sides of the nail or nail fold, or the entire nail or nail fold
◦Sides should not be submitted for payment separately
◦The number of services submitted should be one
◦Exact toe locations should be indicated by using the appropriate modifiers

Palmetto GBA Home / Jurisdiction 11 Part B / Browse by Specialty / Podiatry / Podiatry, Permanent Nail...