Billing > Facility Billing

Billing 11721 with 11055 or 11056

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Ok, I bill for 11721. DX 110.1, 729.5 and 440.20 with the modifier 59
then for the same visit with 11055 DX- 729.5, 701.1

Were those the only two line items on the claim? Was the patient in a 10 or 90 day global period for another procedure? Who is your MAC?  I can say this...if this was one of my claims, for any of the MACS I bill for, and there were no other line items with other diagnoses(say, a DM dx, for instance), and the patient was not in a global, I would bill 11721 just as you have, and the 11055 the same, but also with a 59 modifier. Are you saying you have already tried that, and it denied for wrong modifier on the 11055?

Yes, i have tried it with the 59 modifier and yes these are the only 2 lines on the claim, no other dx.. This is a Medicare claim for NY

I believe 11055 is considered routine foot care and is only covered when the patient has a sytemic disease. CPT 11721 is covered with the DX 110.1 (mycotic nails) and 729.5 (pain), only if the patient is ambulatory. 11055 would not be covered just with the diagnosis pain, without the systemic disease and the qualifying modifiers (Q codes)

The NY MAC is one I do not bill for, and they could have a different which case I would review it, and see what their requirements are for 11055. For all the MAC's I work with, how you billed it is perfectly fine. NY must be stricter with RFC.


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