Author Topic: Billing 11721 with 11055 or 11056  (Read 16989 times)

jennifer8055

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Re: Billing 11721 with 11055 or 11056
« Reply #15 on: April 22, 2014, 10:07:22 AM »
i bill for 5 podiatrists in tennessee and this was the rule of thumb i was given when i started podiatry - for diabetic nail care...11055 (1 callus)/11056 (2-5 callus)removal of corns or callus; 11719 trimming of nails; 11720 (<5 nails)/11721 (>6 nails) debridement of fungal nails....certain combinations require certain modifiers (i.e. 51 or 59).  if the patient is diabetic, you need the appropriate Q7, Q8 or Q9 modifier on it as well.  here's the combinations i use depending on what patient had done.....

11055/11056 Q7,Q8,Q9
11719 51 - Q7, Q8,Q9

11055/11056 Q7,Q8,Q9
11720/11721 59 Q7,Q8,Q9

11720 59 Q7,Q8,Q9
11719 Q7,Q8,Q9

YOU CAN NOT BILL 11721 W/11719 -- no modifiers will allow this
YOU CAN NOT BILL 11720 W/11721 -- not allowed same "procedure" different #

diagnosis codes:

11055/11056    700 (corn/callus)
11720/11721    110.1 (onychomycosis)
11719              703.8 (onychauxis)

those dx codes must be accompanied by either 681.10, 681.11, 719.7 or 729.5 and a systemic condition code of 249.00-249.01, 249.10-249.11, 249.20-249.21, 249.30-249.31, 249.40-249.41, 249.50-249.51, 249.60-249.61, 249.70-249.71, 249.80-249.81, 249.90-249.91, 250.00-250.03, 250.10-250.13, 250.20-250.23, 250.30-250.33, 250.40-250.43, 250.50-250.53, 250.60-250.63, 250.70-250.73, 250.80-250.83, 250.90-250.93; 440.20-440.9, 443.1 & 782.0, 443.0, 443.9, 451.0, 451.11, 451.19, 451.2, 451.81

if i bill a patient w/all three nail care codes - here's how i do it and they're paid 99.9% of the time:
EXAMPLE ONLY:
11056 Q8
11720 59 Q8
11719 59 Q8

dx's of:
110.1
703.8
700
250.60


hope this helps  8)


jennifer8055

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Re: Billing 11721 with 11055 or 11056
« Reply #16 on: April 22, 2014, 10:09:07 AM »
oops....forgot ----- don't forget referring/primary care doctor name on claim along w/patient's date last seen too

djk

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Re: Billing 11721 with 11055 or 11056
« Reply #17 on: May 02, 2014, 10:17:06 AM »
thanks that does help, I have also add for pain, Medicare wont pay on either code unless 729.5 is second diagnosis.  The really odd part is that Medicare is paying on some claims and not others and they are all billed exactly the same way with the same diagnosis, so i have to do written appeals on each one  yikkees LOL thanks for your help

jennifer8055

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Re: Billing 11721 with 11055 or 11056
« Reply #18 on: May 23, 2014, 02:36:36 PM »
it is VERY weird on medicare sometimes w/the pain dx of 729.5.  on our software system there's only space for 4 dx codes -- if patient is having all three procedures done, i can't add 729.5 to the 250.60, 110.1, 703.8, 700 because there simply isn't room.  some claims medicare pays it without the pain dx and sometimes they send a request for records......it's very strange.  i wonder if it just depends on who the processor is.....if there are still actual "claim processors"....

good luck!

Michele

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Re: Billing 11721 with 11055 or 11056
« Reply #19 on: May 23, 2014, 04:13:06 PM »
it is VERY weird on medicare sometimes w/the pain dx of 729.5.  on our software system there's only space for 4 dx codes -- if patient is having all three procedures done, i can't add 729.5 to the 250.60, 110.1, 703.8, 700 because there simply isn't room.  some claims medicare pays it without the pain dx and sometimes they send a request for records......it's very strange.  i wonder if it just depends on who the processor is.....if there are still actual "claim processors"....

good luck!

Is your software updated for the new CMS 1500 (rev 02-12)?  If so there should be room for more dx codes.
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djk

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Re: Billing 11721 with 11055 or 11056
« Reply #20 on: June 16, 2014, 06:56:05 AM »
Software wont allow to map more than 4 dx either i have sent in request for this to be fixed and nothing yet.. yikkes

Michele

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Re: Billing 11721 with 11055 or 11056
« Reply #21 on: June 16, 2014, 07:00:29 AM »
Is your software updated to allow for ICD10?  Are you sure it's not just a setting?  Are software has a place to indicate how many dxs we want to print on a claim.
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RichardP

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Re: Billing 11721 with 11055 or 11056
« Reply #22 on: June 16, 2014, 11:22:07 AM »
Software wont allow ...

Can you tell us the name of your software?

jennifer8055

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Re: Billing 11721 with 11055 or 11056
« Reply #23 on: August 18, 2014, 12:31:39 PM »
We bill on a software called the Sammy systems from ICS Software out of New York.  We still cannot put more than 4 diagnosis codes on the claim, even though we're using the updated (02-12) HCFA claim form and there's spaces for 12 dx codes. 

When I posed the question to our software vendor that we needed to be able to use more than just 4 diagnosis codes, their comment was "it's not a priority right now since ICD-10 was delayed until 2015."  Unless an insurance company sends us something stating we have to be able to use more than 4 dx codes (right now we're having to "split" bill claims w/more than 4 dx codes) our software people said it's just something they will eventually get to.   ::)

I think eventually insurance companies will get tired of seeing split claims come thru from providers and do some type of mandate for everything to be on one claim as much as possible and for us, it seems like we're going to have to wait for that mandate (or October 2015 - whichever comes first) for that to happen.

Jennifer
Mid-South Foot & Ankle Specialists
Cordova, TN

Michele

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Re: Billing 11721 with 11055 or 11056
« Reply #24 on: August 18, 2014, 08:05:19 PM »


When I posed the question to our software vendor that we needed to be able to use more than just 4 diagnosis codes, their comment was "it's not a priority right now since ICD-10 was delayed until 2015."  Unless an insurance company sends us something stating we have to be able to use more than 4 dx codes (right now we're having to "split" bill claims w/more than 4 dx codes) our software people said it's just something they will eventually get to.   ::)


Wow!  That would not be ok with me.  The new form was not delayed and the new form has room for 12 dx codes.  The number of dx codes is completely separate from ICD10.  We have several situations that require more than 4 codes and we were very happy to switch to the new form. 

You are kind of in a hard place unless you are considering switching software.
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coxoffice

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Re: Billing 11721 with 11055 or 11056
« Reply #25 on: September 23, 2015, 05:21:00 PM »
I am trying to use the modifiers you suggested and my billing program says that medicare says there is a bundle error. I'm billing 11719 59 q8 with 250.00 and 703.8 as diagnosis. I've tried it with modifier 51, 99, and still says bundle error. Any suggestions?

Michele

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Re: Billing 11721 with 11055 or 11056
« Reply #26 on: September 24, 2015, 12:05:29 PM »
Not enough info.  What other codes are you billing?
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coxoffice

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Re: Billing 11721 with 11055 or 11056
« Reply #27 on: September 28, 2015, 12:11:47 PM »
billing with 99213-25

kristin

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Re: Billing 11721 with 11055 or 11056
« Reply #28 on: September 28, 2015, 06:16:55 PM »
Okay, so you are billing:
99213-25
11719-59-Q8

Is that all you are trying to bill for this claim? If so, one issue is you do not need a 59 modifier on the 11719, and the Q8 doesn't work with your two diagnoses either. I don't know what dx's you are using on the 99213-25, but if they are the same as for the 11719, it will bundle. If they are different dx's, that is a different story. Another issue is the dx's you are using for the 11719...neither of those two come up on any LCD I use for nondystrophic nails, nor are they listed in the Ingenix Podiatry Coding Companion. Which MAC do you use, and have you checked their LCD for RFC coverage rules?