Watch for coding-policy changes wrapped up in CMS' edits to the 2016 National Correct Coding Initiative (CCI) policy manual. The edits, effective Jan. 1., include lesion-removal and debridement codes.
Notably, CMS says you can bill CPT code 11055 (Paring or cutting of benign hyperkeratotic lesion) with code 11720 (Debridement of nail[s] by any method; 1 to 5) as long as the two procedures are performed on different fingers. The two codes are bundled, but you can use modifier 59 as evidence of the distinct procedure.
“This means that if you are paring a callus on the right great toe near the nail area (11055), you can report 11720 with a modifier 59 if you are debriding the right second and third toes,” explains Margie Vaught, CPC, a consultant based in Chehalis, Wash. “But if you are paring a corn/callus of the right great toe near the nail area and also debriding that great toe nail, you can only report the column-one code [11055].”
For more edits, including E/M and other lesion-removal changes, see the full story that appeared in the Dec. 14 issue of Part B News.