The 59 Modifier

When is it appropriate to bill for the trimming of a callus and the debriding of a nail on the same toe on the same date of service?

EXAMPLE OF MODIFIER 59 USAGE:

• • •  Treatment of the nail, nail bed, and adjacent soft tissue distal to and including the skin overlying the distal interphalangeal joint on the same toe constitutes treatment of a single anatomic site.
  • •  Column 1 Code / Column 2 Code - 11055/11720
  • •  CPT Code 11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus)
  • •  CPT Code 11720 – Debridement of nail(s) by any method(s); 1 to 5

MLN Fact Sheet Proper Use of Modifiers 59 & –X{EPSU}: MLN1783722 March 2022 – Example: Column 1 Code/Column 2 Code – 11055/11720

• • • •  CPT codes 11720 and 11055 should not be reported together for services performed on skin distal to and including the skin overlying the distal interphalangeal joint of the same toe. Modifier 59 should not be used if a nail is debrided on the same toe on which a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint is pared. Modifier 59 may be reported with code 11720 if one to five nails are debrided and a hyperkeratotic lesion is pared on a toe other than one with a debrided toenail or the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which a nail is debrided.

This is my opinion.

Michael G. Warshaw

DPM, CPC

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