Dermatology Coding Alert

Published on Wed Dec 23, 2015 PDF

Question: Can I bill Medicare for an E/M visit (99213) along with a debridement of nails (11721)?

Arkansas Subscriber

Answer: Yes, as long as the documentation clearly illustrates that the nail debridement is determined to be necessary at this visit and that the office visit is separately identifiable.

If so, you will report the nail debridement with code 11721 (Debridement of nail[s] by any method[s]; 6 or more) and the office visit with the 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …) as you suggest. You would attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99213 to indicate the separate service.

You will need to report a relevant diagnosis, such as diabetes to its most specific form, along with any complication or other co-morbid condition, to support the medical necessity.

If the E/M was just to assess the nails and then the physician decides to do the debridement, you can’t bill them both. The documentation would indicate which service to bill.