Wiki Pairing Corn/Callus Codes 11055, 11056, 11057

[VivianaP]

So I have a dermatologist that does a pairing of corn/callus on patient's hands. However some insurances deny the code stating that it is not covered. Because what I have been finding is that it's mainly used as Podiatry. I try to fight it using the clinical policies, for example, Medicare's clinical policy states foot care. Is there another code any other doctors are using to pare the lesion of the hand?

This is an example of one patient's notes:
Plan: Paring Hyperkeratotic Lesion.
A total of 4 lesions located on the right distal dorsal middle finger, right mid dorsal index finger, right ring distal interphalangeal joint, and right distal radial thumb were pared with a 15 blade scalpel. This procedure was medically necessary because the lesions that were treated were: inflamed and irritated.

Any suggestions?

 

[Chelle-Lynn]

The codes 11055-11057 would be the correct code as the corn or callus does not specify a specific body area. A general description of the procedure is:

A benign hyperkeratotic lesion such as a corn or callus is removed by paring or cutting. A corn is a small area of thickened skin. A callus is a larger area of thickened skin. Corns or calluses that press on underlying tissues causing pain, such as corns that form on the toes or calluses that form on the bottom of the feet often require removal. The thickened area of skin is pared down or trimmed using a scalpel. Use 11055 for a single lesion, 11056 for two to four lesions, or 11057 for more than four lesions.

I totally understand your issue as you are correct, Medicare and many other carriers, will not allow for this procedure as it is generally excluded due to podiatry. Other than specific documentation and diagnosis showing that it is not podiatry related...I would be stumped on how to proceed with the denial either. You may want to reach out to your CMS Carrier and see if the CPT code itself is just not a benefit vs. the relationship to podiatry care.

Sorry I did not have an awesome solution for you!

 

[CatchTheWind]

The reason these codes are not covered isn't because they are podiatry codes. It is because they are considered "routine care," which does not require a doctor (whether MD, podiatrist, or any other) to perform. However, if there are extenuating circumstances which make it necessary for this to be performed by a doctor, then it may be payable.

Here's what our MAC (for Florida) has to say about it:

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"The presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease...may pose a hazard when performed by a nonprofessional person on patients with such systemic conditions, and may be covered..."

In other words, it may be covered for a patient with documented diabetes or other conditions which compromise sensation in the extremities.

 

[Sarahp941]

Same Situation

I have had this same issue recently as well. Cigna and BCBS state L84 is actually an "Exclusion of Covered Benefits" and will not even allow an appeal; even if it was medically necessary with underlying condition (diabetes). If that diagnosis in ANYWHERE on the claim (11056 or E/M), they will deny the entire date of service. Medicare will pay but only after we send 2nd level appeal to C2C. Then, they seem to pay. Very frustrating!