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J Posted Tue 30th of October, 2012 17:33:45 PM

How should I bill a 11719 and 11720 ? What position it Medicare looking for ?
How does positioning them effect the second procedure discount?

SuperCoder Answered Tue 30th of October, 2012 20:34:36 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 CPT 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 (CPT 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 CPT 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.

Medicare carriers usually consider nail trimming routine foot care and a noncovered service without a systemic condition and qualifying findings. But Utah's Part B carrier, Regence Blue Cross Blue Shield, will pay you to remove an infected ingrown nail (703.0, Ingrowing nail; 681.11, Onychia and paronychia of toe; or 686.9, Unspecified local infection of skin and subcutaneous tissue). You should report 11765 (Wedge excision of skin of nail fold [e.g., for ingrown toenail]) for this service.

If the ingrowth is not infected, you should report 11719 (Trimming of nondystrophic nails, any number) or G0127 (Trimming of dystrophic nails, any number). Choose the code based on whether the nail is nondys-trophic or dystrophic. Regence (and most other payers) will deny the service as routine foot care, so you should inform the patient that Medicare will deny the service before you trim his nail. If the patient still wants the dermatologist to perform the trimming, he should sign an advance beneficiary notice.

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