Author Topic: 11042/11045  (Read 4017 times)


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« on: April 29, 2014, 01:36:01 PM »
Does anyone have experience w/billing 11042 for wound debridement?  I have a patient that has bilateral toe ulcers (RT Hallux/LT Hallux) that I'm trying to bill to Tricare.  They are denying stating that code can only be billed once per day.  I know that if I have a large wound being debrided it's 11042 for the first 20 sq cm and 11045 for each add'l 20 sq cm....but if I'm doing separate sides/toes, why would i bill a reduced service 11045 on the second toe debridement?  I billed 11042 RT and 11042 LT and we've sent documentation in showing bilateral (maybe i should've used TA and T5 modifiers for even more specificity), but Tricare keeps rejecting.

Is this something i can fight or is it a lost cause?

Thanks for any help!
Jenn ???


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Re: 11042/11045
« Reply #1 on: April 29, 2014, 01:47:30 PM »
You can't bill the 11042 twice for one DOS. You add up the sq. cm debrided, for BOTH toes, and since that is 20 sq. cm's or less, you bill the 11042 once. The 11045 is an add on code, and would only be used if you did more than 20 sq. cm's for all areas debrided. You don't use the LT/RT modifiers for 11042, because skin has no laterality, it is a continuous organ.


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Re: 11042/11045
« Reply #2 on: April 29, 2014, 02:19:15 PM »
That is correct, also with Tricare and some comerical insurance you need to add the 59 modifier.  I have been billing for wound care for 11 years now so good luck...