“Is a plantar keratosis debridement (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”
When contemplating debriding a keratosis at the first metatarsal head (billing CPT code 11055) and also debriding mycotic nails on the same patient on the same date of service (billing CPT code 11720) with the assumption being that this is an “At Risk,” Routine Foot Care Patient, the first step that I would take would be to access the MLN Fact Sheet, “Proper Use of Modifiers 59 & -X {EPSU}.” I would scroll down to:
Example 4: Column 1 Code/Column 2 Code – 11055/11720
• CPT Code – 11055 – Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
• CPT Code – 11720 – Debridement of nail(s) by any method(s); 1 to 5
“Don’t report CPT codes 11720 and 11055 together for services performed on skin distal to and including the skin overlying the distal interphalangeal joint of the same toe. Don’t use modifiers 59 or –X{EPSU} if you debride a nail on the same toe on which you pare a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint. You may report modifier 59 or –XS with code 11720 if you debride 1 to 5 nails and you pare a hyperkeratotic lesion on a toe other than 1 with a debrided toenail or the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which you debride a nail.”
Clearly, in the example given in the above post, the situation does not fit within the exclusion that is demonstrated in “Example #4.” Therefore, since CPT codes 11055 and 11720 are indeed bundled within the NCCI edits, with 11055 being the Column 1 code and 11720 the Column 2 code. However, they can be billed together on the same date of service. The correct coding scenario would be the following:
CPT 11055 – Q_
CPT 11720 – 59, Q_ or 11720 – XS, Q_
This is my opinion.
Michael G. Warshaw,
DPM, CPC
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