Wiki 11055 and 11056 billing issues

[jcoil]

I'm new to billing and have been mostly able to figure things out with my own research, but I cannot get these codes paid by Medicare (Palmetto) - 11055 or 11056. I know they need DLS and PCP name/NPI but can someone tell me EXACTLY how you enter that in Box 19 because I haven't been able to get the correct format yet. Also, do I need to add the PCP as referring provider, or is it sufficient to put the name and NPI in Box 19? Many thanks in advance for help with this.

 

[erjones147]

I'm right there with you on these 2 codes

Are you adding the Q7/Q8/Q9 modifier?

Also, I read somewhere on these forums that L84 has to be the primary dx. Can an experienced podiatry coder weigh in?

 

[boomba003]

11055 and 11056

11055 , 11056, 11057 are used to trim corns and calluses. In California with Noridian, we have a LCD that requires two Dxs. DX1 - L84, DX2 - M79.671 and/or M79.672, and/or M79.674 and/or M79.675. In other words, the corns and calluses must also be painful for Medicare Coverage.

We use the Class Findings modifiers Q7, Q8 or Q9 for the nail debridement codes only (11720 or 11721). Have not had any problems with reimbursement.