Routine Foot Care

Emmalia

Networker
Messages
26
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My group has started receiving denials for 11055-11057 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus)). I've reviewed the updated LCD with ICD10 diagnosis listed and was very surprised to find that L84 (Corns and callosities) is not listed as a covered diagnosis anymore for these codes. Has anyone else come across this problem yet or am I missing something??
Thanks in advance!!
 

espressoguy

Expert
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406
Location
Tacoma, WA
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CPT 11055-57 are carved out in the LCD and if you scroll down past the long list of diagnoses for the other CPTs covered by this LCD you'll find the section that lists the diagnoses for 11055-57, of which, L84 is one of them.

I'm in Noridian country, but I assume the LCDs should be similar.
 

Emmalia

Networker
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26
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Thank you both for your feedback! I'm in NY (NGS Jurisdiction) and I've looked through the LCD multiple times and it's not listed anymore.
 

nprayer2

Networker
Messages
26
Location
Maryville Illinois
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11056

We are recently receiving denials as well for the 11056 not being medically necessary--the dx billed is L84. I have READ and re-READ the referenced LCD L33636(IL)and cannot find this dx anywhere. What's even stranger is that we have been using/billing this dx for years and it has paid but according to some sources, this dx has never been a covered dx but IL Medicare still paid.

Has anybody heard from the source (Medicare) about the reason for these denials after years of paying?
 

missyah20

Guru
Messages
222
Location
Minneapolis
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11055/11056

Good Evening All -

I am working with WPS Medicare and when they updated their LCD in February it appears that they as well changed it to only pay for codes 11055/11056 when the patient has a systemic disease. All of my previously paid paid codes are no longed payable.

Am I going to have to tell my Dr that she will need to look at implementing ABNs for this procedure??

I am curious to know what others are doing since these codes are being pd anymore.

Thanks All!!
 
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