Wiki billing 11042 and 11721 together

[kdrummelsmith@yahoo.com]

Hello - I work for a podiatry practice. I've noticed that we struggle to get 11042 and 11721 paid when billed together. We always append a 59 mod on the 11721, however, we still get a rejection, normally on the 11721, citing LCD problems. When I look at the claims, we ARE following all the appropriate LCD rules (although the LCD for 11721 is no longer - it appears Medicare and the rest of the insurance companies pretend like it's still there!). When I try to call and speak to reps - they just repeat what the EOB says - that LCD rules have been violated. Anyone else have this issue - or have any advice? Thanks!

 

[thescientist8]

What DX did you have for 11042? I usually assign different DX on both (of course based on MR) and add 59 on 11721.

 

[kdrummelsmith@yahoo.com]

What DX did you have for 11042? I usually assign different DX on both (of course based on MR) and add 59 on 11721.

I had an L97.522 on the 11042, and a B35.1, M79.674, M79.675 on the 11721.

 

[sevvie200]

We put an XS on both, or if the payer prefers modifier 59 we put that on both...as long as the ulcer isn't at the DIP or more distal on the digits of the nails that are being trimmed...then it can't be unbundled.