Wiki Medicare and 11720

[RebeccaMoney]

We just got a denial for medical necessity for CPT 11720. Medicare has an LCD for 11720 listed as foot care only, no mention of hand/finger. This procedure was done on a finger and, of course, none of those diagnosis on the LCD are for the finger. Has anyone ever had luck getting 11720 paid for the finger from Medicare? What was your strategy? The only thing I can think of is to include the finger modifier. The diagnosis was L03.012 for finger cellulitis which Encoder Pro shows as acceptable. Thank you,

 

[amyjph]

This is tough to answer without a procedure report or knowing why the procedure was done on the fingernail(s). Some questions I would have are: was it really 11720 and not avulsion or matirixectomy, etc.? Did they have an open fracture or a laceration that went through the nail or was it just cellulitis (no open wounds, etc)? Was there something else done at the same time like I&D? Does the patient have any co-morbid conditions such as diabetes or something else? I am guessing even for the hand the procedure may not be covered.