Know the Documentation Requirements for Anti-Fungal Treatments
Question: A patient presents to our podiatry practice with fungal nails, and the podiatrist pared multiple corns and applied an anti-fungal treatment to the patient’s nails. When billing 11055-11056 with 11720-11721 to Medicare or Medicare replacement plans, is the provider required to document the anti-fungal treatment? AAPC Forum Subscriber Answer: Yes, documenting the anti-fungal treatment is required in order to receive reimbursement for 11720 (Debridement of nail(s) by any method(s); 1 to 5) or 11721 (… 6 or more) when you’re billing the debridement with 11055-11056 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus) …). According to the Centers for Medicare & Medicaid Services (CMS) Billing and Coding article A57672, the physician must document the which nails were affected by the infection, how the nails were debrided, and “[u]se of appropriate anti-fungal treatment or the contraindication of such treatment must also be documented.” Examples of ICD-10-CM codes that show medical necessity for the debridement procedures include: Mike Shaughnessy, BA, CPC, Production Editor, AAPC
