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Thread: Toe nail debridement and callous removal

  1. #1

    Default Toe nail debridement and callous removal

    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?

  2. #2

    Default 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/NationalCorre...modifier59.pdf

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