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Toe nail debridement and callous removal

KimAS

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Per CCI edits, we can bill 11055 and 11721 together, as long as we put a 59 modifier on 11721. Caresource is now denying this-saying mutually exclusive. Not sure where they are getting their information. Has anyone else been getting this denial?
 

Lamon Willis

Networker
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Modifier -59

Assuming there is medical necessity for both procedures, modifier -59 is acceptable per current quarter NCCI edits. CMS guidelines provides the following information related to this similar topic:

"EXAMPLES OF MODIFIER -59 USAGE
Example: Column 1 Code/Column 2 Code 11055/11720

CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion CPT Code 11720 – Debridement of nail(s) by any
method(s); one to five

Policy: Mutually exclusive procedures

Modifier -59 is:

1) Only appropriate if procedures are performed for lesions anatomically
separate from one another or if procedures are performed at separate
patient encounters.

2) Don't report CPT codes 11055-11057 for removal of hyperkeratotic skin
adjacent to nails needing debridement."

Reference: http://www.cms.hhs.gov/NationalCorrectCodInitEd/Downloads/modifier59.pdf
 
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