Podiatry services billing
Priority Health considers debridement of hyperkeratotic lesions (11055-11057) not separately reimbursable when performed with nail debridement (11720-11721) on the same digit, based on National Correct Coding Initiative (NCCI) guidelines, Chapter 3.
Documentation within the operative note should resemble the lay description of the CPT or HCPCS code selected. Documentation for repeated procedures on different anatomical sites (fingers, toes, limbs), spinal levels, or paired organs should clearly detail each distinct procedure and support its medical necessity.
Documentation must include:
- The digit/location needing debridement
- The size of the lesion/debridement area
- The size (including thickness) and color of each affected nail
- Medical necessity for the debridement
- Debridement approach/surgical technique
Insufficient documentation examples
- Documentation of location(s) ONLY within physical exam or objective area of the note. See Practitioner office review standards in this Manual for more.
- Documentation states only, "debridement of all affected nails," or "all hyperkeratotic lesions were debrided." Documentation must detail which nails or calluses were debrided or the extent to which they were debrided.
Hyperkeratotic lesion debridement procedure codes
11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
11056 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions
11057 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions
Nail debridement procedure codes
11720 - Debridement of nail(s) by any method(s); 1 to 5
11721- Debridement of nail(s) by any method(s); 6 or more
Payable: When performed without nail debridement on the same digit and submitted with required documentation
Not payable: When performed with nail debridement (11720-11721) on the same digit. A modifier appended to indicate distinct services will not override this edit.
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