Wiki Callus with Ulcer underneath

[Melissa*Ever*Evolving]

Hi, Dr works in a Wound Center inside a hospital (billing for physician charges)... We are billing a callus removal along with the debridement of an ulcer after callus was removed...is that correct? I need proof that we shouldn't be billing this together since it is the same spot! pt has diabetic ulcer...

(Anthem insurance)
11042>707.15, 250.60
11055-59>250.60, 700
denied 11055

I cannot find anything from Anthem on their guidelines about this...

But across the board, can we bill both if debridement was done right after they removed the callus?
Help!

 

[Stacixu04]

No, callus with an ulcer underneath is just considered an open wound so you would need to use either 11042-11047 or 97597-97598 depending on how deep the physician goes.

Paring of callus codes are typically not payable - most insurance companies do not consider routine foot care a benefit. Also, the paring of callus code is specifically for hyperkeratotic skin - not open wounds. Also, you should not use 700 because it is not a true "callus". The more appropriate ICD-9 codes would be 250.60 and one of the 707.1 codes (depending on what part of the foot it is on).