LCD Reference Article Billing and Coding Article

Billing and Coding: Debridement of Mycotic Nails

A56640

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A56640
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Debridement of Mycotic Nails
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
09/12/2019
Revision Ending Date
N/A
Retirement Date
N/A

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

Please refer to the related LCD, L35013.

Article Guidance

Article Text

Refer to the Novitas Local Coverage Determination (LCD) L35013, Debridement of Mycotic Nails, for reasonable and necessary requirements and frequency limitations.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

CPT codes 11720 and 11721 will not be reimbursed more often than once every 60 days.

CPT codes 11720 and 11721 may be limited to 6 sessions per beneficiary, per 12 months. Refer to the Utilization Guidelines in the related LCD for information related to this limitation.

Response To Comments

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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

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(17 Codes)
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It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. 

Medicare is establishing the following limited coverage for CPT/HCPCS codes 11720 and 11721.

Note
: ICD-10-CM code B35.1 must appear on each claim in addition to one of the other ICD-10-CM codes below that indicates secondary infection, pain, or difficulty in ambulation.

Group 1 Codes
Code Description
B35.1 Tinea unguium
L02.611 Cutaneous abscess of right foot
L02.612 Cutaneous abscess of left foot
L03.031 Cellulitis of right toe
L03.032 Cellulitis of left toe
L60.0 Ingrowing nail
M79.604 Pain in right leg
M79.605 Pain in left leg
M79.661 Pain in right lower leg
M79.662 Pain in left lower leg
M79.671 Pain in right foot
M79.672 Pain in left foot
M79.674 Pain in right toe(s)
M79.675 Pain in left toe(s)
R26.2 Difficulty in walking, not elsewhere classified
R26.89 Other abnormalities of gait and mobility
R26.9 Unspecified abnormalities of gait and mobility
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
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ICD-10-PCS Codes

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Group 1 Codes

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Additional ICD-10 Information

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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. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

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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. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
09/12/2019 R2

In addition to the update below, due to system changes, the coding section of this Article has been reorganized and a new section for modifiers has been added.

09/12/2019 R1

Article revised and published 9/12/2019. CPT code 11721 has been added to the article text to be consistent with the LCD language. 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35013 - Debridement of Mycotic Nails
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
09/06/2019 09/12/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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