Wiki Nail Debridement with corn removal

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RADCODER

RADCODER

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Not Medicare patient-

The provider debrided ALL toes on both feet due to fungus and removed a corn on Left great toe. Provider is billing,
11055
11721-59.

Is the 11721 appropriate to bill with the modifier 59?
I understand the Left great toe was debrided as well as had a corn removed. (which is inclusive of each other) However would this coding scenario be applicable for the remainder of the toes debrided?

Any thoughts are greatly appreciated!!

This is per Medicare:
Example 4: Column 1 Code / Column 2 Code - 11055/11720
>CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
>CPT Code 11720 ? Debridement of nail(s) by any method(s); one to five
CPT code 11720 should not be reported and modifier 59 should not be used if a nail is debrided on the same toe from which a hyprkeratotic lesion has been removed. Modifier 59 may be reported with code 11720 if multiple nails are debrided and a corn that is on the same foot and that is not adjacent to a debrided toenail is pared.
 
Thank you for your input. I was unsure because they are inclusive to each other, So the 59 is representing that the remaining toes that underwent nail debridement is separate from the corn removal of the Left Great toe?
 
Understood the toenail is NOT the toe. Again Medicare gives the example of, "Modifier 59 may be reported with code 11720 if multiple nails are debrided and a corn that is on the same foot and that is not adjacent to a debrided toenail is pared" But in my case, ALL toes (which means left great toe as well) were debrided in addition the Left Great Toe underwent corn removal. Wouldn't that be considered the SAME foot? Which in return would not allow the 59? Or are you allowing the 59 (11721) for the remaining 9 toenails that underwent the nail debridement?
 
What Medicare seems to be saying is that if you debride a only 1 toenail and remove a corn on the same toe (same foot, adjacent to toenail) then you shouldn't bill it. The fact that the provider debrides the other 4 toenails (not adjacent to the corn) is what makes this billable.

While I disagree with Medicare on this on an a theoretical basis, I can't recall any of my podiatrists (I code for 3) debriding only 1 toenail while removing a corn from the same toe.
 
11055-11056/Dx 700

has anyone else noticed that no matter how in the world you code for corn removal Medicare denies?!?!?! It's so aggravating because most often these are not cosmetic. They are elderly patients who have large painful corns that make it hard to even walk! And I follow their guidelines very specifically! When I call I get someone who just tells me they're it's not covered with no explanation or that I need a Q modifier, which most often doesn't apply when it's a corn.
 
tdvrobertson said:
has anyone else noticed that no matter how in the world you code for corn removal Medicare denies?!?!?! It's so aggravating because most often these are not cosmetic. They are elderly patients who have large painful corns that make it hard to even walk! And I follow their guidelines very specifically! When I call I get someone who just tells me they're it's not covered with no explanation or that I need a Q modifier, which most often doesn't apply when it's a corn.
Click to expand...

My MAC is Noridian and the governing LCD is 24374.

Per this LCD, CPT11055-57 requires at least one of the following diagnoses; 700, 701.1 or 757.39

PLUS

at least one of these diagnoses; 686.9 or 729.5

I have never had an issue with Medicare paying for this as long as the encounter meets the above criteria.

I would check to see if this LCD or another applies in your area.
 
11055/11720

Thank you so much for replying!
My LCD appears to be the same or similar to yours. And I do code as you describe, the primary Dx followed by 729.5 (in most cases).

To be sure--the cpt 11055 should be listed first, with 11702 second with modifier 59, correct? (Did you mean modifier 59 rather than 57?)

Also, would you put the Q modifier before the 59 or after?

And when the patient has the diabetic conditions, it is not necessary to add the Q modifier, is that correct?

Your input would be greatly greatly appreciated!
 
11055/11720

Thank you so much for replying!
My LCD appears to be the same or similar to yours. And I do code as you describe, the primary Dx followed by 729.5 (in most cases).

To be sure--the cpt 11055 should be listed first, with 11702 second with modifier 59, correct? (Did you mean modifier 59 rather than 57?)

Also, would you put the Q modifier before the 59 or after?

And when the patient has the diabetic conditions, it is not necessary to add the Q modifier, is that correct?

Your input would be greatly greatly appreciated!
 
To get the 11056 code to pay i had to put a XS modifier on the 11721 and the Q8 or Q9 modifier next to 11056 as well as the patients PCP on the referring provider AND the supervising provider. Hope this helps to anyone else who has had the nightmare of this code not paying.
 
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