Does 11721 need a modifier?

Does 11721 need a modifier?

CPT code 11721 (Covered Nail Debridement 6 or more) requires Q8 modifier (for routine check-up) with systemic conditions which is medically necessary to be reimbursed by Medicare but only six times in a year.

How often can you medicare 11721?

every 60 days
Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure.

What is the CPT code for nail debridement?

11721
When reporting debridement of mycotic nails (CPT codes 11720, 11721), the primary diagnosis representing the patient’s dermatophytosis of the nail must be listed, as well as the secondary diagnosis representing the systemic condition.

How do I bill 11721 to Medicare?

Procedure Code 11720 or 11721 are included in Medicare’s covered foot care when billed with a diagnosis pertaining to debridement of nail. Refer to the Diagnosis Code List. Procedure Code G0127 is included in Medicare’s covered foot care when billed with a diagnosis pertaining to dystrophic nails.

How do I bill Medicare for routine foot care?

Generally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare can be found in Publication Number 100-02 Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services, Section 290.2 Routine Foot Care.

What is a GY modifier used for?

The GY modifier must be used when physicians, practitioners, or suppliers want to indicate that the item or service is statutorily non-covered or is not a Medicare benefit.

Does Medicare pay for diabetic toenail clipping?

Medicare doesn’t normally cover nail clipping or any kind of routine foot care. You’re correct that diabetes mellitus is one of the medical conditions that may justify coverage — but only if: A doctor has been treating you for diabetes in the six months before the nail clipping, and.

Does Medicare pay for nail debridement?

Medicare will cover debridement of nail(s) by any method(s); 1 to 5 and/or debridement of nail(s) by any method(s); 6 or more no more often than every 60 days.

How do you Debride your toenails?

Nail debridement involves removal of a diseased toenail bed or viable nail plate. This may be performed manually with an instrument, or with an electric grinder. Podiatrists generally provide nail debridement to patients diagnosed with onychomycosis (i.e., mycosis or mycotic toenails).

Is toenail debridement painful?

Let’s now look at the definitions. Debridement of Toenails: Nail debridement involves the significant reduction in the thickness and length of the nail to the tolerance of the patient with the aim of allowing the patient to ambulate without pain.

What is the difference between 11719 and 11720?

11719 applies when the nails are void of defects from nutritional or metabolic abnormalities. (in other words – healthy). 11720-11721 includes trimming and shaping of the nails as well as debridement.

Does Medicare pay for podiatrist to cut toenails?

NonCovered Foot Care The cutting of toenails in a healthy person or when they are not painful is not a payable service by Medicare. The cutting of corns and calluses in a healthy person is not a payable service by Medicare. Legally, your podiatrist cannot try to obtain Medicare payment for noncovered foot care.

Does Medicare pay for a podiatrist?

Medicare Part B covers podiatry services for medically necessary treatment of foot injuries, diseases, or other medical conditions affecting the foot, ankle, or lower leg.

Is GY modifier patient responsibility?

Modifier GY will cause the claim to deny with the patient liable for the charges. Do not use on bundled procedure or on add-on codes. You may use this modifier in combination with the GX modifier.

Why are my toenails growing so thick?

Toenails that grow thicker over time likely indicate a fungal infection, also known as onychomycosis. Left untreated, thick toenails can become painful. Prompt treatment can be key to curing the nail fungus. Fungal infections might be difficult to cure and may require months of treatment.

How do I get rid of thick toenails?

Applying a small amount of melted coconut oil can help heal thick yellow toenails. You can purchase over-the-counter (OTC) antifungal nail creams and ointments. Be sure to clip and clean your nails before use to make sure the creams reach deeper layers. Laser therapy can be used to treat a fungal toenail infection.

How do you Debride thick toenails?

Dystrophic Toenails Dystrophic nails can be thinned through manual sanding, however, the quickest and most effective way to sand very thick toenails is with an electric sanding device. Thick nails should be sanded to avoid ulcerations due to shoe pressure, and can be sanded as thin as you desire.