Podiatry services

Applies to:

All plans

Medical policy:

Foot Care, 91121

Podiatry services billing

Priority Health considers debridement of hyperkeratotic lesions (11055-11057) not separately reimbursable when performed with nail debridement (11720-11721) on the same digit, based on National Correct Coding Initiative (NCCI) guidelines, Chapter 3.

Documentation requirements

Documentation within the operative note should resemble the lay description of the CPT or HCPCS code selected. Documentation for repeated procedures on different anatomical sites (fingers, toes, limbs), spinal levels, or paired organs should clearly detail each distinct procedure and support its medical necessity.

Documentation must include:

  • The digit/location needing debridement
  • The size of the lesion/debridement area
  • The size (including thickness) and color of each affected nail
  • Medical necessity for the debridement
  • Debridement approach/surgical technique

Insufficient documentation examples

  • Documentation of location(s) ONLY within physical exam or objective area of the note. See Practitioner office review standards in this Manual for more.
  • Documentation states only, "debridement of all affected nails," or "all hyperkeratotic lesions were debrided." Documentation must detail which nails or calluses were debrided or the extent to which they were debrided.

Hyperkeratotic lesion debridement procedure codes

11055 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion

11056 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions

11057 - Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions

Nail debridement procedure codes

11720 - Debridement of nail(s) by any method(s); 1 to 5

11721- Debridement of nail(s) by any method(s); 6 or more

Payable: When performed without nail debridement on the same digit and submitted with required documentation

Not payable: When performed with nail debridement (11720-11721) on the same digit. A modifier appended to indicate distinct services will not override this edit.

Read more

Hyperkeratotic lesion MLM Matters article

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