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Toe nail debridement and callous removal

  1. Default Toe nail debridement and callous removal
    Clearnace Sale
    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. 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:

    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."


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