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CODINGLINE CORNER

06/30/2010     




Query: CPT 11740 Denial

How do I successfully bill CPT 11740 (evacuation of subungual hematoma) and CPT 11721 on the same claim? I billed CPT 11740-TA (ICD-9 924.3 - contusion of lower limb and of other and unspecified sites; toenail); and CPT 11721 59 (ICD-9 110.1 - onychomycosis - and ICD-9 729.5 pain).

The payer is Medicare (Michigan). They denied the first code stating, "procedure code is inconsistent with the modifier used or a required modifier is missing. Not covered when performed during the same session/date as a previously processed service." They paid CPT 11721. I've also billed the same codes on another claim using modifier "-LT" for CPT 11740, same diagnoses, and got the same result.

Karen, Biller, Office of Isidore Steiner, DPM, Howell, MI

Response: The key to your code pair question lies with the NCCI. When you look up these 2 codes, CPT 11740 is a column 2 to CPT 11721 which is the column 1 code. This means CPT 11740 gets the "-59" modifier, not CPT 11721. Note: some edits just require an anatomic modifier. This should solve your problem.

David J Freedman, DPM, CPC, Silver Spring, MD

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