Wiki IS 11750 always once per lifetime per patient ?

[GJackson]

I have a provider who performed a 11750 ta/t5 and then less than a month later has patient back in and wants to code that again. I said its a once per lifetime per toe. Because its a permanent removal. He said its a revision procedure, he then asked for 11730 same toes? I have seen claims denied for 11750 being billed more than one time per toe. Does anyone have any ideas ? how to code this ?

 

[iowagirl77]

Because 11750 is defined as 'Excision of nail and nail matrix, partial or complete', I can see where it would be payable at separate surgeries on the same toe. You could do a partial excision due to the ingrown nail on one side, then have issues on the other side of the existing nail. I think where we run into trouble is when they do both sides of the nail in one surgery and try to bill 2 units for the same nail.

Are you saying he wants to bill 11750 and 11730 together, or 11730 instead? Billing 11750 and 11730 in the same surgery on the same toes bundles and I would only bill 11750.

 

[podcoder70]

You can now code a repeat 11750 with a KX modifier indicating that there is documentation supporting the repeat procedure. Be sure the documentation clearly states why the procedure needed to be repeated. If 11750 was performed, do not code another procedure just to get paid, that is fraud.