Wiki Cpt question on 11055

[donnagullikson]

We are in Georgia and cannot get the 11055's paid for nothing. We are following the LCD guidelines but are still not getting paid. Is there anyone on this forum coding billing these and getting paid? Can this CPT be billed along with debridement or does it have to be billed alone? Which is what we are doing and they also do 11055.

Thanks,
Donna Gullikson

 

[espressoguy]

There are 2 LCD's that govern CPT 11055. They are LCD 24356 and LCD 24374. I'm going to go out on a limb (no pun intended) and suggest that you are not meeting medical necessity per LCD 24374.

Per LCD 24374 there are only 3 dx that meet medical necessity for 11055:

700
701.1
757.39

In addition, a secondary dx of 686.9 or 729.5 must also be present.

 

[donnagullikson]

We have followed these guidelines and we are still getting denials. Makes me wonder if we are using the correct CPT. The patient has a wound and its debrided. The next week at the follow-up appt the physician cuts away callus from around the wound. Is this still 11055?

Thanks,

 

[Dgarrett12]

Modifer Q7, Q8, Q9

In J12 LCD L27486 Routine Foot Care for Novitas, it guides me to realize that the 11055 needs to be billed with a HCPC modifier Q7, Q8, or Q9 . I have been researching this today quite a bit, and you need to identify the Class while billing for Routine Foot Care. I resubmitted all our claims today that were denied because we were missng a modifier so i am 98% sure this is correct.