Are you trying to find simpler solutions since you’re having trouble with podiatry coding? We are here to help you with medical coding, so don’t worry.
Podiatry is a crucial medical specialty in the USA. Almost 87% of people experience foot discomfort at some point. However, running a podiatry practice is quite challenging.
Podiatry coding is complex because of the ever-changing coding standards. Before filing claims for reimbursement, podiatrists must be fully informed about the correct codes and stay updated on the revisions.
This blog post will explore and clarify CPT code 11721, which typically relates to nail debridement.
CPT Code 11721 – Description
CPT code 11721 covers the nail debridement procedure. To be more specific, it refers to a surgical procedure where a podiatrist debrides or removes six or more nails. In short, healthcare providers use this code to report the treatment of any fungal disease, infection, or any other nail illness that may require the removal of nails.
So, what happens during this procedure? Depending on the condition and severity of a disease, the surgeon removes six or more nails entirely or just their affected portion. This nail removal service is typically performed under local anesthesia. The primary purpose of this surgical procedure is to relieve patients’ pain.
However, it is essential to remember that nail debridement is different from nail trimming.
Scenarios Where CPT Code 11721 is Applicable
This code is applicable in various clinical situations such as fungal infection, psoriasis, or athlete’s foot. These conditions usually affect males aged 60 or older. However, psoriasis occurs regardless of age, gender, or ethnicity.
Fungal Infection (Onychomycosis)
Let’s say a man gets a nail injury that compromises the nails’ defenses, allowing the fungus to enter and cause an infection. He complains of having thick, brittle brown nails when he visits your office. When you closely examine his circumstances. You find out that the injury has caused a fungal infection on his nails and that the damaged nails need to be debrided immediately.
Now, if your clinic has debrided all of the nails the fungus has impacted (at least six of them), you will apply CPT code 11721 to collect reimbursement for your services.
Infection in Athlete’s Foot (Tinea Pedis)
Consider a 70-year-old obese man feeling frustrated due to stinging rashes on his feet and experiencing burning and itching on the skin. At first, he ignores this infection, but as the illness spreads, it begins to damage his toenails. So, he finally decides to visit a clinic.
The podiatrist evaluates his condition and decides to debride six affected toenails. In this case, CPT code 11721 will be used.
Nail Psoriasis (Psoriatic Onychodystrophy)
Think of a situation where a teenage girl with poor immunity comes to your practice with discomfort in her toenails or itchiness. Upon running a careful examination, you diagnosed her with a condition called psoriatic nail. Her psoriasis has produced a rapid accumulation of skin cells, resulting in thick, scaly plaques that can break and bleed. This condition leads to urgent debridement.
If your practice debrides six or more affected nails, this process will call for CPT code 11721.
Applicable Modifiers for CPT Code 11721
The following are some modifiers that may be used with CPT 11721, depending on the situation.
Modifier 59
This modifier denotes that the procedure or service was distinct from other services performed on the same day. Modifier 59 is applied when no other descriptive modifier is available that best depicts the scenario. It helps you avoid claim denials due to bundling issues.
Modifier GZ
You can append this modifier to trigger an automatic claim denial if you think the service is not covered under the patient’s Medicare plan. Medicare typically does not cover routine foot care, considering it unreasonable and unnecessary. The procedure can continue, nevertheless, provided the patient has a secondary payer who can cover the claim.
Modifier Q8
You can apply modifier Q8 to CPT code 11721 when you debride a patient’s toenails due to any two systemic disorders from the following:
- Absent posterior tibial pulse
- Absent dorsalis pedis pulse
- Advanced trophic changes (at least three of the following):
- Hair growth (decrease or absence)
- Thickening of the nail (nail changes)
- Discoloration (pigmentary changes)
- Changes in skin texture
- Changes in skin color (rubor or redness)
Modifier Q9
You can use CPT code 11721 if you performed the procedure due to one Class B (mentioned above) and two Class C findings, such as:
- Claudication (muscle pain due to lack of oxygen)
- Cold feet
- Edema (swelling due to fluid buildup in tissues)
- Paresthesia (Unusual spontaneous sensations in the feet)
- Burning
CPT Code 11721 – Billing & Reimbursement Guidelines
You must follow these billing and reimbursement guidelines to get fair compensation for CPT code 11721:
Verify Medical Necessity & Coverage Requirements
Before proceeding with the procedure, you must verify its medical necessity and whether it is covered by the patient’s insurance plan. For example, Medicare does not cover any costs for routine services.
Use CPT Code 11721 Correctly
You must understand the correct use of CPT code 11721. Remember, this code covers the surgical treatment of both feet, or in simple words, the debridement of six or more toenails. If you carry out this procedure for fewer nails or only on 1 foot, use another code (e.g., CPT code 11720 for debriding 1 to 5 toenails).
Furthermore, CPT code 11721 refers to a surgical process with a 0-day global period, covering pre-, intra-, and post-operative care only on the day of the procedure. Therefore, you should separately bill any follow-up care or services beyond that day.
Document the Entire Procedure
As a podiatry services provider, you must document every procedure that you are performing for the treatment because Medicare and every insurance company require medical reasoning for the procedure. Detailed documentation helps explain the medical necessity of the procedure and highlights the symptoms or diagnosed conditions from findings (B&C).
Follow Billing Rules Determined by the Payer
Review each insurance company’s billing requirements before filing a claim for CPT code 11721. For example, Medicare requires proper reasoning for the nail debridement procedure and only pays for six sessions of CPT code 11721 per year for one patient.
Summary
In short, CPT code 11721 deals exclusively with the debridement of six or more toenails. However, providers can use modifiers to indicate any additional services they have provided to the patient. To receive full payment for your services, you must be well-versed in all billing and payment guidelines established by each insurance payer.
We are aware of the challenges podiatrists face while juggling their clinical and non-clinical responsibilities, such as correctly using CPT codes for billing. We advise you to acquire professional podiatry billing services to lower the likelihood of payment rejections.
