For the “At Risk,” Routine Foot Care patient, can a mycotic toenail be debrided, and a corn/callus be trimmed on the same toe?
Proper Use of the 59 Modifier - “Distinct Procedural 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 or finger 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.
What about the great toe?
- The great toe does not have a DIPJ and a PIPJ. It only has an IPJ.
- So?????
- The above rule does not apply to the great toe.
For the “At Risk,” Routine Foot Care patient, can a dystrophic toenail (HCPCS Level II code G0127) or a non-dystrophic toenail (CPT code 11719) be trimmed, and a corn/callus be trimmed on the same toe?
- When the NCCI edits are accessed, CPT codes 11055, 11056 and 11057 are NOT bundled with either HCPCS Level II code G0127 or CPT code 11719.
- Therefore, CPT code 11719 or HCPCS Level II code G0127 and CPT code 11055 should 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 be used if a nail is trimmed on the same toe on which a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint is pared.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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