Question 11055 denial ? dx

ltl226

Contributor
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Location
Boxborough, MA
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Hello,

I have been reading the forums regarding CPT 11055 and I am having a tough time finding an answer. We have been receiving denials with diagnosis L84, B07.8, B07.0, and/or L53.8. I work for a dermatology practice. Our MAC is NGS JK. Any thoughts or advise would be greatly appreciated.

Thank you,
Laura
 

SharonCollachi

True Blue
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Location
Clovis, CA
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Not sure if this is from your MAC or not, but here is one policy:

11055 & 11056 with Neuropathy Diagnosis-Medicare Coverage

For callus care 11055 and 11056 are they covered under medicare if they only have neuropathy as a diagnosis.


For the removal of corns and calluses, neuropathy is one of the covered systemic conditions covered by Medicare. Per the Medicare LCD on routine foot care, below are the covered diagnosis codes relating to neuropathy:


  • A52.15 (Late syphilitic neuropathy)
  • E08.41 (Diabetes mellitus due to underlying condition with diabetic mononeuropathy)
  • E08.42 (Diabetes mellitus due to underlying condition with diabetic polyneuropathy)
  • E08.43 (Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy)
  • E10.41 (Type 1 diabetes mellitus with diabetic mononeuropathy)
  • E10.42 (Type 1 diabetes mellitus with diabetic polyneuropathy)
  • E10.43 (Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy)
  • E11.41 (Type 2 diabetes mellitus with diabetic mononeuropathy)
  • E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy)
  • E11.43 (Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy)
  • E13.42 (Other specified diabetes mellitus with diabetic polyneuropathy)
  • G13.0 (Paraneoplastic neuromyopathy and neuropathy)
  • G60.0 (Hereditary motor and sensory neuropathy)
  • G60.2 (Neuropathy in association with hereditary ataxia)
  • G60.3 (Idiopathic progressive neuropathy)
  • G60.8 (Other hereditary and idiopathic neuropathies)
  • G61.1 (Serum neuropathy)
  • G61.81 (Chronic inflammatory demyelinating polyneuritis)
  • G61.89 (Other inflammatory polyneuropathies)
  • G62.0 (Drug-induced polyneuropathy)
  • G62.1 (Alcoholic polyneuropathy)
  • G62.2 (Polyneuropathy due to other toxic agents)
 
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