Wiki Medicare 11055,11056,11057 diagnosis issues (l85.1 or l84)

[tionna]

Hello!

I am the only biller/coder for a large podiatry group. We have received notification regarding changes with LCD/NCD for our area. (Knoxville,TN) We normally bill routine foot care codes 11055,11056,11057 with the diagnosis of L85.1 (callus), along with E11.49 (diabetes w/ neuro) OR I73.9 (pvd) as the secondary code and a Q modifier for the class finding. We are being informed that we can no longer use the L85.1 AND L84 (which we have never used). Is there another related callus code that can be used that is billable and payment has been received? We are currently not billing RFC and just changing it to a level 3 visit until we can get this issue resolved. Please Help! Thanks so much!

 

[mitchellde]

If the service provided meets the qualifications of the codes you mention then you cannot opt to code these as a 99213. If the service provided is not covered due to the diagnosis then you need to obtain an ABN and make the service a patient responsibility. It depends exactly how the provider documents the patient diagnosis as to what or how I would code it.

 

[vbnails]

Per our LCD (Georgia), 11055, 11056, 11057 are covered Medicare services only with a systemic disease diagnosis such as Diabetes, PVD, etc and must meet the physical findings as outlined in the LCD. Primary dx for the service would be the systemic disease with the addition of the Q modifier to the CPT code indicating physical findings documented in exam.

Vicci Nails, CPB, CSFAC

 

[alsherron3]

Hi,
I am in the same situation you're in. We are located in Cary, NC and our Medicare is through Palmetto GBA (which I believe is the same as yours). I have used D23.71 (RT) and D23.72 (LT) with 11055-11057 which has paid for some patients but not other patients. I was also advised by a mentor to switch the primary and secondary dx codes and see if that worked. It didn't. I know this probably isn't much help, but it's all I have at this point.