Nail

“I have a question concerning Medicare’s rules when billing for repeat CPT 11750. What is the recommendation for billing these for a regrowth following a previous CPT 11750? In another scenario, on the same subject, what if the procedure needs to be performed on a nail border that is adjacent to one that was already billed? Can and should we use an ABN and upon denial, bill the patient?”

“I have a patient with a longitudinal striation of her toenail, and we are going to biopsy the nail bed. What ICD-10 do code would you consider for the diagnosis for the biopsy? What is the CPT procedure code for the nail matrix?”

“We are inquiring about the use of the Q7 modifier when billing nail and callus debridement with Medicare. We are aware of the changes to the LCD with diagnosis codes. When billing nail debridement CPT 11721 and callus debridement CPT 11056, we are submitting diagnosis codes Z89.412 and Z89.422, (acquired absence of toe) with a Q7 modifier to show “non-traumatic amputation of a foot or an integral skeletal part of the foot.” Now we are being told by Medicare that per the LCD, we cannot bill those diagnosis codes even with a Q7 modifier. Should we be billing with a different modifier?”

“We have billed CPT 11730 for all 10 nails using the appropriate toe modifiers. Anthem Blue Cross paid for five of the toes but is denying the other five. The denial comes back with CO-222 (Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific.) Please advise.”