Part B Insider (Multispecialty) Coding Alert

Published on Thu Oct 25, 2012 PDF

Question: My physician saw a patient with one hyperkeratotic lesion on the left foot and five hyperkeratotic lesions on the right foot. Can I bill codes 11055 and 11057 together with RT and LT modifiers since the lesions are on separate feet?

Answer: When you're dealing with codes 11055 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion), 11056 (... two to four lesions), and 11057 (... more than four lesions), you should only report one code that represents the total number of lesions the doctor removed. If you try to bill 11055 and 11057 -- even with RT (Right side) and LT (Left side) modifiers -- you'll most likely get a denial.

The right way: Suppose the physician removed corns from a patient who had one on each foot. The correct code would be 11056 because the total number of corns removed was two. In your case, the total number of lesions from both feet is six, so you would report 11057.