Wiki Minor procedure done with E/M

jkottarathil

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Hello,

I'm not positive if this belongs in this category, but I wasn't sure where else to put it. I have a situation where the provider reported toenail debridement (11721) as well as a separately identifiable E/M (99336). The E/M service is definitely supported in the documentation. However, I don't believe the same is true for 11721. Neither a systemic condition nor a secondary code/condition (to use in conjunction with B35.1) is mentioned. I'm wondering is it more appropriate for me to remove CPT 11721 from claim as it would then be considered bundled with the E/M service? Or would it be more appropriate to append modifier GZ (an ABN was not issued so this is the more appropriate modifier to use) to 11721 and leave it on the claim? Any help is appreciated!
 
Hello - in my past life when I coded routine podiatry, I would still code the 11721 and append the modifier GZ for Medicare.
It is a service provided to the patient, and the presence of modifier GZ does two things: 1) you are accurately representing the services provided without coding/billing Medicare for services that are non-covered as if they were covered and 2) if the patient has a secondary payer that might reimburse the claim, you get your Medicare denial to allow that process to move forward.
Also bonus - you can run a report of 11721 with modifier GZ and use that as education to physicians on what type of details to include in their documentation when they are providing medically necessary services.

I hope that helps.

Kim
www.codingmastery.com
 
Hello - in my past life when I coded routine podiatry, I would still code the 11721 and append the modifier GZ for Medicare.
It is a service provided to the patient, and the presence of modifier GZ does two things: 1) you are accurately representing the services provided without coding/billing Medicare for services that are non-covered as if they were covered and 2) if the patient has a secondary payer that might reimburse the claim, you get your Medicare denial to allow that process to move forward.
Also bonus - you can run a report of 11721 with modifier GZ and use that as education to physicians on what type of details to include in their documentation when they are providing medically necessary services.

I hope that helps.

Kim
www.codingmastery.com
Thank you so much! This is very helpful!
 
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