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Callus with Ulcer underneath

  1. #1
    Question Callus with Ulcer underneath
    Medical Coding Books
    Hi, Dr works in a Wound Center inside a hospital (billing for physician charges)... We are billing a callus removal along with the debridement of an ulcer after callus was that correct? I need proof that we shouldn't be billing this together since it is the same spot! pt has diabetic ulcer...

    (Anthem insurance)
    11042>707.15, 250.60
    11055-59>250.60, 700
    denied 11055

    I cannot find anything from Anthem on their guidelines about this...

    But across the board, can we bill both if debridement was done right after they removed the callus?

  2. #2
    No, callus with an ulcer underneath is just considered an open wound so you would need to use either 11042-11047 or 97597-97598 depending on how deep the physician goes.

    Paring of callus codes are typically not payable - most insurance companies do not consider routine foot care a benefit. Also, the paring of callus code is specifically for hyperkeratotic skin - not open wounds. Also, you should not use 700 because it is not a true "callus". The more appropriate ICD-9 codes would be 250.60 and one of the 707.1 codes (depending on what part of the foot it is on).

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