icd-10-cm code for debridement, mycotic toenails

What is the CPT code for nail debridement?

In addition, the local symptomatology caused by each affected nail resulting in the need for debridement must be documented. For CPT code 11720 documentation of at least one nail will be accepted. For CPT code 11721 complete documentation must be provided for at least 6 nails.

Does Medicare cover mycotic nail debridement?

As with other Medicare-covered services, mycotic nail debridement must be reasonable and necessary for the treatment of an illness or injury or to improve the functioning of a malformed body member. Medicare payment generally may be made for mycotic nail debridement in the two following circumstances:

Are mycotic nails covered under routine foot care?

Wounds Infections Treatment of mycotic nails may be covered under the exceptions to the routine foot care exclusion (requires two DX) 14 Part B Indications of Coverage

What is the CPT code for nail trimming?

The same coverage guidelines for Medicare apply to both codes. As far as a DX code, for routine nail trimming (non-covered), look at 703.8 - Hypertrophic nails - basically, long nails. Hope this is helpful.

What is debridement of mycotic nails?

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).

How do you bill for nail debridement?

If the toenails are documented as non-dystrophic or essentially “normal” toenails, the appropriate code to bill is CPT code 11719. If the toenails are documented as mycotic, the appropriate CPT code to bill based upon the number of toenails that are debrided is either CPT 11720 or CPT 11721.

What is the CPT code for debridement of 10 nails?

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.

Does Medicare cover debridement of nails?

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.

What is a mycotic nail?

A mycotic nail is a fungal infection that affects your toenails or fingernails. It separates your nail from your nail bed, making it thick and fragile. It may change colors. The word “mycotic” means an infection with a fungus or a disease caused by a fungus. Mycotic nails are also known as onychomycosis.

What is the CPT code for debridement?

For example, CPT code 11042 defined as “debridement, subcutaneous tissue” should be used if only necrotic subcutaneous tissue is debrided, even though the ulcer or wound might extend to the bone.

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.

What is a non dystrophic nail?

Normal nails that are not defective from metabolic or nutritional abnormalities.

What is the difference between G0127 and 11721?

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.

Does Medicare cover toenail clipping for diabetes?

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.

Can you bill G0127 and 11721 together?

Medical Necessity CPT codes 11719, 11721 & G0127 should not be billed together to avoid inclusive denials If the insurance company denies the claim even when the modifier is billed correctly, CCI (Correct Coding Initiative) edits should be checked and appealed with appropriate medical records.

Can 11721 and 11055 be billed together?

Area of focus: Proper reporting of nail trimming, nail debridement, and lesion trimming and appropriate modifier usage. CPT® codes 11720 – 11721 and 11055 – 11057 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.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.

Article Guidance

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Routine Foot Care and Debridement of Nails.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

How often does Medicare cover mycotic nail debridement?

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. Medicare will not cover 11721 in the absence ...

Does Medicare cover mycotic nails?

Medicare will cover debridement of mycotic nails as an adjunct to pharmacologic treatment with a prescription antifungal agent indicated per its Food and Drug Administration (FDA) label for the treatment of fungal nail infections.

Does Medicare require a detailed clinical description of mycotic nail debridement?

Medicare does not require the detailed clinical description to be repeated at each instance of mycotic nail debridement when an earlier record continues to accurately describe the patient’s condition at the time of the foot care.

What is the ICd 10 code for mycotic nails?

For treatment of mycotic nails, or onychogryphosis, or onychauxis (codes 11719, 11720, 11721 and G0127), in the absence of a systemic condition or where the patient has evidence of neuropathy, but no vascular impairment, for which class findings modifiers are not required, ICD-10 CM code B35.1, L60.2 or L60.3 respectively, must be reported as primary, with the diagnosis representing the patient’s symptom reported as the secondary ICD-10-CM code. Refer to the “Indications and Limitations of Coverage and/or Medical Necessity” section of the related LCD.

How often is foot care considered medically necessary?

Routine foot care services are considered medically necessary once (1) in 60 days. More frequent services will be considered not medically necessary. Services for debridement of more than five nails in a single day may be subject to special review.

What codes are used for global surgery?

Global surgery rules will apply to routine foot care procedure codes 11055, 11056, 11057, 11719, 11720, 11721, and G0127. As a result, an E&M service billed on the same day as a routine foot care service is not eligible for reimbursement unless the E&M service is a significant separately identifiable service, indicated by the use of modifier 25, and documented by medical records.