CPT code 11720 is for the debridement of 1 to 5 nails, a procedure to remove damaged or infected nail tissue.
CPT code 11720 is used to describe the medical procedure of debriding, or removing, up to five nails. This typically involves the removal of damaged or infected portions of the nail to promote healing and prevent further complications. This code is often used in podiatry and dermatology practices.
For CPT code 11720, the following modifiers may be applicable:
1. Modifier -59 (Distinct Procedural Service)
- Used to indicate that the debridement of nails is distinct or independent from other services performed on the same day.
2. Modifier -76 (Repeat Procedure by Same Physician)
- Applied when the same procedure is repeated by the same physician on the same day.
3. Modifier -77 (Repeat Procedure by Another Physician)
- Used when the same procedure is repeated by a different physician on the same day.
4. Modifier -78 (Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period)
- Indicates an unplanned return to the operating room for a related procedure during the postoperative period.
5. Modifier -79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period)
- Applied when an unrelated procedure or service is performed by the same physician during the postoperative period.
6. Modifier -Q7 (One Class A Finding)
- Used to indicate that the patient has one Class A finding, which justifies the medical necessity of the procedure.
7. Modifier -Q8 (Two Class B Findings)
- Indicates that the patient has two Class B findings, supporting the medical necessity of the procedure.
8. Modifier -Q9 (One Class B and Two Class C Findings)
- Applied when the patient has one Class B and two Class C findings, justifying the medical necessity of the procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
CPT code 11720 is reimbursed by Medicare, but it is essential to verify the specific reimbursement details through the Medicare Physician Fee Schedule (MPFS). The MPFS provides the payment rates for services covered by Medicare, including CPT code 11720. Additionally, reimbursement can vary based on the region, as Medicare Administrative Contractors (MACs) may have different local coverage determinations (LCDs) and policies. Therefore, healthcare providers should consult their respective MAC for precise information regarding the reimbursement of CPT code 11720.
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