01/30/2019

Correct Billing for 11765

Hi, When billing 11765 we are getting the denial "PAYMENT ADJUSTED - PAYER DEEMS INFORMATION SUBMITTED DOES NOT SUPPORT THIS MANY FREQUENCY OF SERVICES" and or "11765 cannot be allowed with modifier 50/LT/RT". Can you suggest billing options ?

When billing for a nail wedge fold excision, this procedure should only be billed with the appropriate toe modifier that the procedure was performed on. Site modifiers such as -LT and -RT are not appropriate because there are more specific modifiers that can be used for billing purposes. The -50 modifier should not be used for this minor procedure because if the service was provided bilaterally, the service should be billed for one service per line item with the applicable -T modifiers. Modifier -59 should not be reported to an insurance if the procedure was performed on multiple digits, since the specificity of a toe modifier shows that each procedure is performed on a separate toe.