Routine Foot Care - 11055 & 11721

BHCM

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Appleton, WI
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I have a podiatrist that consistently bills 11055/56 w/11721 for his Medicare patients. I have not been able to get Medicare to pay for the 11055/56 no matter how I code them. I continually get a denial for modifier invalid or missing. My understanding is that it should be coded this way:

11055 -Q9 (RT, LT or 50)
DX: 110.1, 703.8, 440.22(or 250...)

11721 - 59,Q9
DX: 110.1, 703.8, 440.22 (or 250...)

Medicare will pay the 11721 but deny the 11055 every single time.

What am I missing? Do I need to use 729.5 also? Is it the RT, LT, 50 modifiers that are incorrect?

Any help would be much appreciated. **Note, our Medicare does not list 700 as a payable dx for the 11055 in the LCD
 

twoerpel

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Monroe, WI
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Routine Footcare

Modifiers RT/LT and 50 are not appropriate for codes 11055-11057 "Excision Benign Hypertrophic Skin Lesions". You bill by total number of lesions debrided not per foot as the left and right foot are considered the same anatomical site.

When looking at the diagnosis to use for 11055-11057 keep in mind that Medicare states in the billing/coding guidelines for Routine Foot Care and Debridement of Nails that a provider should "Report the ICD-9 code for which the service(s) is performed in the first position in the diagnosis field of the CMS 1500 claim form or electronic equivalent; report the systemic
condition(s) in the remaining positions.

You wouldn't perform a debridement of a lesion for dx 110.1.

I hope this helps you out.
 

dstruve

Networker
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Spencer, IA
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11055 - Q9 701.1
G0127 - 51 Q9 703.8 443.9

11055 - Q9 701.1
11721 - 51 Q9 703.8 443.9

very rarely have I ever been denied. appeal and send in documentation.
 

espressoguy

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Tacoma, WA
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You don't need LT/RT or 50 modifiers.

In our area, Noridian will only pay 11055-57 for these 3 dx: 700, 701.1, or 757.39 with a secondary dx of 729.5 or 686.9
 

Porter_kd

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Ortig, WA
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Routine Foot Care is very specific and tricky to follow. With Noridian. I have read many times our "Routine Foot Care" LCD, which has expired, but they do still follow it. 11055 or 11056 are for paring or cutting of corns or calluses. My Podiatrist uses many terms for these, like heloma, hyperkeratosis, etc. Typically diagnosis code 700 should be used for this code. This should be listed as the first diagnosis code, as that is the reason why you are doing the procedure. For Routine Foot Care, the patient needs a systemic condition to cover foot care and the Q7, Q8 or Q9 modifiers if needed. Some diagnosis codes don't require the Q modifier. Like TWOERPEL stated, no LT, RT or 50 is needed for these codes.
 
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