|
#1
03-16-2010, 06:13 PM
|
|||
|
|||
Toe nail debridement and callous removal
Per CCI edits, we can bill 11055 and 11721 together, as long as we put a 59 modifier on 11721. Caresource is now denying this-saying mutually exclusive. Not sure where they are getting their information. Has anyone else been getting this denial?
|
|
#2
03-17-2010, 09:00 AM
|
||||
|
||||
|
Modifier -59
Assuming there is medical necessity for both procedures, modifier -59 is acceptable per current quarter NCCI edits. CMS guidelines provides the following information related to this similar topic:
"EXAMPLES OF MODIFIER -59 USAGE Example: 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 Policy: Mutually exclusive procedures Modifier -59 is: 1) Only appropriate if procedures are performed for lesions anatomically separate from one another or if procedures are performed at separate patient encounters. 2) Don’t report CPT codes 11055-11057 for removal of hyperkeratotic skin adjacent to nails needing debridement." Reference: http://www.cms.hhs.gov/NationalCorre...modifier59.pdf
|
