Wiki Podiatry refresher please

[Kirstyn20]

I used to bill for a podiatry office for several years but have not billed for one for the past year and a half. I am now starting to bill for another one and I seemed to have forgot some of my skills! lol
This new podiatrist mainly only bills for nail debridement and callus trims.
As far as I can remember, with the 11721's the primary dx will be 110.1 and 2ndary will be 729.5. For the 11056's I will bill w/ primary dx of 700 and follow up w/ systemic disease dx (250.00, 443.96 etc) appending the Q modifier to the 11056.
11721-59 (110.1, 729.5)
11056-Q8 (700, 250.00)

Does the above scenario look correct??

Thanks!!

 

[CFlick]

If you are billing only for debridement of painful, mycotic nails, then 11720 or 11721 with 110.1 followed by 729.5 (or other qualifying dx) would be correct.

However, if you are billing for both procedures on the same patient, the Q8 would be appropriate on both CPTs. In addition, the -59 modifier belongs on the second CPT.
I would code the following:

11721, Q8 (110.1, 250.00, 443.9)
11056, 59,Q8 (700, 250.00, 443.9)

Then of course, the name of the physician treating the complicating disease process and the date s/he last saw the patient (within the last six months) must be added to the claim.

Hope this helps. Don't worry--it's like riding a bike! (albeit an unusual bike) You'll be back in the swing in no time.

 

[debber]

What about if you are billing 11721 and 11055. Would that be the same as the codes above?

And what about 11719 and 11721

 

[rhopkins]

you cannot bill 11721 with 11719. You can only bill the 11719 with 11720 adding a 59 modifier on the 11720. Code 11721 is debridement of 10 nails.

 

[Dnolan313]

I have been a podiatric coder for the past 15 years. 1105X, 11720 and 11719 are billable together.However, there are two separate guidelines to consider :
1) Painful pathological nail - treatment of an acute condition such as an ingrown nail.
2) Routine Foot care treatment of nondystrophic or mycotic nails with an at risk conditions that require a medical professional to perform the treatment.

1) If the primary reason for the treatment is due to pain ICD-9-CM Codes 110.1, 228.01 and 703.8 are covered only when these conditions cause pain, or marked limitation in ambulation or function.
An example would be :
11055 701.1 729.5
11720 -59 110.1 729.5
11719 ( not covered )

2) Routine Foot care is covered only when a systemic disease and their peripheral complications increase the danger for infection and injury if a nonprofessional provides these services. There must documented evidence which discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement. These indications are coded by appending the CPT with the appropriate "Q" modifier.
See: http://www.cms.gov/Outreach-and-Edu...oads/MedicarePodiatryServicesSE_FactSheet.pdf
An example would be :

11055 Q8 700 , 443.9
11721 Q8 59 110.1 443.9
11719 Q8 51 443.9

remember , documentation must be present that supports your choice of "Q" modifiers