Billing > Facility Billing

Billing 11721 with 11055 or 11056

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jennifer8055:
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:
oops....forgot ----- don't forget referring/primary care doctor name on claim along w/patient's date last seen too

djk:
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:
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:

--- Quote from: jennifer8055 on May 23, 2014, 05:36:36 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!

--- End quote ---

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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