Wiki 11755 and 11720

[GJackson]

I am new to podiatry and have a ? about 11755 and 11720, the Provider keeps trying to bill this one and I don't believe its even documented, also trying to bill 87101 and 87220. to me the biopsy is a separately done procedure this to me looks incidental. please see note and advise...

Procedures
Nails 1 right sharply, mechanically debrided and trimmed with nail nippers and curette as needed due to dystrophic nails and patient's comorbidities. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of soft tissue infection, drainage, or malodor present.

Nail unit of the left hallux sharply, mechanically debrided and trimmed with nail nippers and curette due to dystrophic nails and patient's chief complaint. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of infection, drainage, or malodor present. Nail unit was then sent for fungal culture and KOH prep in setting of dystrophic nails to look for nail unit infection.

 

[lgardner]

I am new to podiatry and have a ? about 11755 and 11720, the Provider keeps trying to bill this one and I don't believe its even documented, also trying to bill 87101 and 87220. to me the biopsy is a separately done procedure this to me looks incidental. please see note and advise...

Procedures
Nails 1 right sharply, mechanically debrided and trimmed with nail nippers and curette as needed due to dystrophic nails and patient's comorbidities. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of soft tissue infection, drainage, or malodor present.

Nail unit of the left hallux sharply, mechanically debrided and trimmed with nail nippers and curette due to dystrophic nails and patient's chief complaint. Nails were debrided down to and including nail plate from the dorsal aspect including proximal, medial, and lateral nail folds this is done without incident and patient tolerated procedure well. Nails were wiped with alcohol prior to debridement. Nail beds and surrounding soft tissue in stable condition. No clinical signs of infection, drainage, or malodor present. Nail unit was then sent for fungal culture and KOH prep in setting of dystrophic nails to look for nail unit infection.

I will preface this with saying that I do not code podiatry.

but from what you have described, the provider is not doing a biopsy. they are sending a specimen for a culture.
they can not bill for a biopsy OR a culture, since they are not performing either of these.

 

[podcoder70]

Oh goodness...I see this quite often. 11755 is a biopsy of a nail unit. This is often used, incorrectly, to send a nail clipping to pathology to confirm tinea unguium (fungus). The issue I have is that your doctor is has put all the "right words" into the documentation to support the 11755, however, I suspect that he/she is NOT anesthetizing the toe first. To bill a 11755 one has to remove the plate, bed, matrix, hyponychium, AND proxima/lateral nail folds...this would be very painful without anesthesia. The code is intended primarily to look for cancer and should not be billed often, in my opinion. A nail clipping, is just a clipping and has no additional code. Sending that clipping to pathology to confirm fungus, unfortunately, is not separately billable.
As to the 87101 and 87220 are lab codes. Does the doctor have his/her own pathology lab in office? Some do. They must be CLIA certified and that cert# must be on the claim. If they are, then one or both of those codes would be appropriate to bill.

 

[GJackson]

Oh goodness...I see this quite often. 11755 is a biopsy of a nail unit. This is often used, incorrectly, to send a nail clipping to pathology to confirm tinea unguium (fungus). The issue I have is that your doctor is has put all the "right words" into the documentation to support the 11755, however, I suspect that he/she is NOT anesthetizing the toe first. To bill a 11755 one has to remove the plate, bed, matrix, hyponychium, AND proxima/lateral nail folds...this would be very painful without anesthesia. The code is intended primarily to look for cancer and should not be billed often, in my opinion. A nail clipping, is just a clipping and has no additional code. Sending that clipping to pathology to confirm fungus, unfortunately, is not separately billable.
As to the 87101 and 87220 are lab codes. Does the doctor have his/her own pathology lab in office? Some do. They must be CLIA certified and that cert# must be on the claim. If they are, then one or both of those codes would be appropriate to bill.

Perfect and thank you I will have to find out about the lab ?

 

[GJackson]

I will preface this with saying that I do not code podiatry.

but from what you have described, the provider is not doing a biopsy. they are sending a specimen for a culture.
they can not bill for a biopsy OR a culture, since they are not performing either of these.

thank you for your reply!