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J Posted Wed 13th of June, 2012 17:32:17 PM

How should we bill 11720,11719,29550,99335 with modifiers
Medicare is attaching the 51 Mod and paying less on the 11719
It also looks as if we position 11719 first they pay the allowed amount?

SuperCoder Answered Wed 13th of June, 2012 19:00:06 PM

First, you should know the difference between nail trimming and nail debridement. Trimming of a nail is a procedure that is intended to reduce only the length of the nail. Your podiatrist can perform this service on a normal nail or a dystrophic nail. Meanwhile, debridement of a nail is a procedure that is intended to remove excessive material (e.g., to significantly reduce nail thickness/bulk) or excessive curvature from a clinically and significantly thickened dystrophic or diseased nail. It's also important you look at the LCD for individual regions for guidence with nail care.

Code it: You should use 11720 (Debridement of nail[s] by any method[s]; 1 to 5) when debriding a total of one to five nails and 11721 (Debridement of nail[s] by any method[s]; 6 or more) for debriding greater more than six nails. Again, one may trim a dystrophic nail (G0127, Trimming of dystrophic nails, any number) or a non-dystrophic nail (11719, Trimming of nondystrophic nails, any number).

The physician may also choose oral and topical antifungal treatment courses, which would be monitored in follow-up visits.

There are other options for treating fungal nails and tinea. It is perfectly acceptable to schedule follow-up visits to monitor the progress of oral and topical antifungal treatment courses. Considerations and evaluations of possible treatment protocol changes constitute an E/M service.

Tip: Payers do not reimburse debridement of nails as an adjunct to oral or topical therapy separately from E/M unless the patient meets "at-risk" or painful nail criteria. Make sure you check for regulations regarding the use of specific qualifying secondary diagnosis and Q modifiers that need to be listed on the claim form.
When an internist trims an ingrown nail, you should report 11719 (Trimming of nondystrophic nails, any number). If the physician didn't document systemic findings, such as diabetes (250.xx), Medicare will not reimburse this service. The government payer considers 11719 routine foot care.


J Posted Wed 13th of June, 2012 19:20:50 PM

Thank you!

Here is what we bill Here is what they pay
99305 -25 100%
10060-TA 100%
11720 -Q8,59 50%
11719 -Q8,59 for this code Medicare auto adds a 51 MOD and pays almost nothing like 3.00 of a bill of 29.60

It is the 11719 I am wondering about is it in the wrong position should we always bill the 11719 before the 11720? and why are they adding the MOD 51 and why is it paid almost at nothing . I know about multiple proc discounts but they are discounting even more.
Any help you can offer?


SuperCoder Answered Wed 13th of June, 2012 19:51:14 PM

Resolving Billing Issues In Routine Foot Care:

Coding for routine foot care still raises blood pressure throughout podiatry. Unfortunately, given the multiple Medicare carriers and the policy variations with each carrier, it can get very confusing.

CPT 11720, 11721, G0127 and 11719 are allowed for covered routine foot care for “at-risk” patients. Generally, Q modifiers are required only for vascular-based ICD-9 codes. The allowable systemic, vascular and neurologic ICD-9 codes may vary by carrier.

CPT 11720 and 11721 are also allowed for coverage for painful dystrophic nails in patients who are not at risk. Before billing care of symptomatic nails, check with the Medicare carrier for specific rules. When you are billing for the debridement of painful dystrophic nails, Medicare will only pay for those nails that one documents as being painful by history and examination. One should always include as much objective data as possible to document the fact that nails are painful and limit ambulation. Simply listing “the patient states they hurt” may not be enough.

Carefully align nail care procedures with nail ICD-9 codes.Sloppy billing often results in denials when billing for treatment of these conditions. Also be careful to clearly list and align at-risk conditions and painful conditions with the appropriate ICD-9 codes on the claim form.

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