02/28/2020

Payments for CPT 11720 and G0127

I am not being paid for the combination of 11720 and G0127 on my office (11) and home visits (12). I am using 11720 59q8 with G0127Q8. The diagnosis used is I70.203 B351 m79671 and L60.2. They are just paying the 11720 code. The reason given is CO 236 which is The procedure is not compatible with another procedure provided on the same day and missing/incomplete data from submitted claim. Strangely enough on my nursing home patients ( 32) they are paying for this combination. Any ideas?? Thanks

A nail debridement is a slightly more complex procedure than a nail trimming, HCPCS code G0127 should be reported with modifier -59. A corrected claim should be submitted with the modifiers switched, which should allow for payment for both nail procedures. The class finding modifiers for systemic condition nail care, and diagnosis codes reported should not cause any issues with reimbursement. Depending on the payer, an appeal may be necessary to get payment for the denied procedure, especially since the POS should not have impact on bundling for these minor procedures.