08/24/2018

Proper Billing for Bilateral Nail Avulsions on All Toes-Excellus BC/BS

DID BILATERAL AVULSIONS ON ALL TOES - OBVIOUSLY ACCORDING TO EXCELLUS I BILLED IT WRONG - PLEASE ADVISE HOW TO FILE - DID 50 51 AND THEN BOTH T CODES ON EACH LINE

If a nail avulsion was done on all ten toenails, below is the way that it should be billed to Excellus BC/BS- note that surgical procedures on the toes, even if done bilaterally, should not be billed with Modifier 50 or Modifier 51. Each procedure should be listed only with the applicable toe modifier (TA, T1, T2, etc).

For the first avulsion, the CPT code should be 11730, billed for one unit of service, appended with one modifier (-TA)

For every subsequent avulsion, CPT 11732 should be reported as the add-on code, billed for one unit of service, appended with one toe modifier (T1, T2, T3, etc.)

 If all ten toes had the procedure done, there should be ten line items total (11730 billed once, 11732 billed nine times).  I would however make sure that the documentation is accurate and adequate to reflect the need as it is unusual to perform this procedure at the same time on all ten toes and may rejected for medical necessity.