Author Topic: G0127  (Read 2764 times)

jennifer8055

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G0127
« on: May 23, 2014, 02:42:21 PM »
Does anyone have experience in billing G0127 for trimming of dystrophic nails?

I have Medicare patients w/dx of 250.60, 110.1, 700

11055/11056 removal callus(es)
11720/11721 debridement of fungal nail(s)
G0127 trimming of dystrophic nails

Example of coding used:

11056-59-Q8
11720-59-Q8
G0127-Q8

We were told by our local MAC that 11721 wasn't payable w/G0127, only the 11720.  But we still have some that are getting kicked out as G0127 non-covered.  I was always taught to put the -59 modifier on the more "expensive" charges so that's why their on the 11056 & 11720.  Does the "Q" code not go on the G0127 code?

Any help would be greatly appreciated!!

Thanks!
Jennifer   ???
MSFAS
Cordova, TN

Michele

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Re: G0127
« Reply #1 on: May 23, 2014, 04:22:34 PM »

Example of coding used:

11056-59-Q8
11720-59-Q8
G0127-Q8

We were told by our local MAC that 11721 wasn't payable w/G0127, only the 11720.  But we still have some that are getting kicked out as G0127 non-covered.  I was always taught to put the -59 modifier on the more "expensive" charges so that's why their on the 11056 & 11720.  Does the "Q" code not go on the G0127 code?


I'm assuming you are a biller and not a coder.  The reason I say that is because the advice of " put the -59 modifier on the more "expensive" charges" is not correct.  You should never just put a modifier anywhere.  Modifiers are as important as the cpt codes and they should only be appended to the cpt code if the patient's notes support that modifier.  If you are just putting the modifier on the "more expensive codes" then you don't really know if the notes support that or not or if the modifier is appropriate or not.  I'm telling you this because as a biller you can be in trouble if there is ever an audit and they determine that the modifiers were simply added to get payment.

With that being said, there really is no way to know why the claims you are referring to are being 'kicked out' without more information.  What denial specifically is being received on them?
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