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CPT Code 11721

  1. Default CPT Code 11721
    Medical Coding Books
    We are billing a cpt code of 11721 with a Q9 modifier for medicare. We are using the following diagnosis code 250.60, 357.2, 110.1

    We are not getting paid by medicare for these services. We also are making sure we put the Endocriologist NPI number or the Family Physician NPI number & the last date seen.


    Is anyone else having this problem or anyone have any suggestions


    thanks

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Does the documentation support the nail fungus code? I only ask as I have run across thru audit a fair number of podiatry claims using the 110.1 code with no documentation of the mycosis. Can you give the documentation of the diagnosis for one of these?

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Grand Rapids, MI
    Posts
    230
    Default
    What is the rejection you are getting?

  4. Default
    Are you coding 110.1 as the primary diagnosis? If not this could be the problem.

  5. #5
    Location
    Detroit Chapter
    Posts
    76
    Default
    make sure you include the date in box 15

  6. #6
    Default
    make sure to review the LCD for 11721 it has all the information needed. 110.1 should be primary if the documentation supprorts this dx. Also make sure to use 11720 if only 1-5 nails are done and 11721 if 6-10 are done. Getting these paid can be difficult, but follwoing the LCD should help make it smoother.
    EVELYN KIM , MBA, CPC, CPMA,CRC

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