Treating patients and managing their symptoms is a great responsibility for healthcare providers. However, it becomes more challenging for them when the practice’s administrative work adds to their job, such as medical billing.
Medical billing is a complex yet crucial process for every healthcare practice. It involves reporting minute details for the payment of your services. CPT codes are one of them. Like all providers, podiatrists have to use the correct CPT codes and modifiers for reimbursement of their services.
In this blog, we will cover CPT code 11056 and all the information related to it to help podiatrists file clean claims.
CPT Code 11056 – Description
CPT code 11056 reports the removal of a non-cancerous growth on the skin that thickens the outer dermal layer. It usually appears as a rough bump or a scaly patch on the skin.
An accurate description of the code is “ the removal of two or four benign hyperkeratotic lesions using a surgical instrument”.
This code only deals with the removal of 2-4 lesions. So, fewer than two or more than four lesion removals will not be reported using this code.
Scenarios Where CPT Code 11056 is Applicable
Let’s understand the use of CPT code 11056 with some real-life scenarios.
Corns and Calluses
Let’s imagine that a diabetic person in his 60s comes to your clinic with blisters and small round bumps that are now forming thick patches on his feet. Initially, due to diabetes, the affected part turned numb, and he didn’t feel any painful sensations. Upon a thorough check-up, those thick patches appear infected. The provider immediately removes them through a surgical process. He carries out the process on two middle toes and a big toe. Hence, in this case, he can apply CPT code 11056.
Plantar Warts
Plantar warts are one of the most common diseases in the USA. Almost 10% of people suffer from this disease.
Suppose a patient in his 70s comes to your clinic with a small wart on his left foot. After a thorough check-up, the physician removes it through a surgical process. He administers local anesthesia on the affected area and cuts the warts using a surgical knife (scalpel). The procedure is performed on the big toe and three middle toes. He may apply CPT code 11056 for reimbursement.
Seborrheic Keratosis
In another case, an elderly patient above 50 years of age comes to you with some oval-shaped scaly patches on the skin. These patches form a thick layer on the big toe, little toe, and one of the middle toes. The podiatrist removes these patches through a surgical instrument (shave excision, curettage, or electrocautery). Since the podiatrist has removed these patches from three toes, he can claim for his services using CPT code 11056.
Applicable Modifiers for CPT Code 11056
Modifiers are used with CPT codes to provide extra information to the insurance payers. It is important to append the correct modifiers (when needed) with CPT codes; otherwise, the payer can reject your claim request. The following are some commonly used modifiers with CPT code 11056.
Q8 Modifier
Usually, Medicare does not cover routine foot care services except under certain scenarios. Modifier Q8 is used with the CPT code 11056 if the patient has two Class B findings.
Q9 Modifier
Similarly, the healthcare provider may apply modifier Q9 with CPT code 11056 if there were one Class B and two Class C findings.
LT Modifier
This modifier is used to indicate the location where the procedure was conducted by a podiatrist. The LT modifier explains that the lesion removal occurred on the left foot.
RT Modifier
A podiatrist can append this modifier with CPT code 11056 if he has performed services on the right foot.
T-Modifiers
The podiatrist uses T-modifiers (T1-TA) to specify the foot and toe where he performed the surgery.
| Modifiers For Toenails | |
|---|---|
| T1 | Left foot, second digit |
| T2 | Left foot, third digit |
| T3 | Left foot, fourth digit |
| T4 | Left foot, fifth digit |
| T5 | Right foot, great toe |
| T6 | Right foot, second digit |
| T7 | Right foot, third digit |
| T8 | Right foot, fourth digit |
| T9 | Right foot, fifth digit |
| TA | Left foot, great toe |
GY Modifier
Modifier GY is applied when a services are statutorily excluded or not covered by Medicare. It triggers an automatic claim denial.
CPT Code 11056 – Billing & Reimbursement Guidelines
These billing and coding guidelines may save you from potential claim denials and payment delays.
Report the Accurate Code
The healthcare service provider needs to report the correct code for fair reimbursement. If he applies the wrong code, it may lead to underpayment or payment delays. CPT code 11056 is only applied when at least two benign hyperkeratotic lesions are removed through a surgical process, and a maximum of four. If you have removed lesions on one or more than four toes, CPT code 11056 will become ineligible for your services.
Ensure Medicare Coverage
It is important for a healthcare provider filing for reimbursement to determine whether Medicare covers those services or not. Medicare has indicated that it does not cover routine foot treatments, including:
- Cutting and removing corns and calluses.
- Nail trimming, cutting, clipping, or debridement.
- Any hygiene treatment, such as cleaning.
Unless the service is medically necessary. Therefore, you must prove the medical necessity of 2-4 lesion removal.
Use Modifiers Correctly
Modifiers provide extra information to the insurance payers. Applying a correct modifier when needed can help you receive fair reimbursement. However, incorrect application of modifiers can lead to severe repercussions as well, such as penalties and audits for upcoding.
We have mentioned some modifiers that are used with CPT code 11056 in the section above to aid your understanding.
Conclusion
In this blog, we have covered almost every detail that a healthcare provider should know before reporting CPT code 11056 for reimbursements. This code explains the removal of thick skin (benign hyperkeratotic lesion) on the feet, but there is a limitation. CPT code 11056 is only applied when the 2 to 4 lesions are removed surgically.
If you need professional help or want someone to manage all the billing nuances, you can outsource podiatry billing services to experts. They possess the knowledge and skills required for efficient medical billing, while staying up-to-date with regulatory changes.
