11/13/2020

Correct Billing for CPT 11730 & 10060

would like to know the correct ICD10 for paronychia L03.032 or L02.611 Both denied by Healthfirst with CPT 10060 and correct modifier

In order for both services to be reimbursed by Health First, a corrected claim needs to be submitted with coding following Medicare guidelines:

-The nail avulsion (CPT 11730) should be billed as the first procedure with L60.0 as the primary diagnosis and L03.032 as the secondary diagnosis, and the -TA modifier as primary.

-The simple I&D (CPT 10060) should be billed as the second procedure only with diagnosis L02.611, with modifier -59 to unbundle this procedure from the nail surgery. Site or toe modifiers are not appropriate to bill for this minor procedure.

When submitting the corrected claim to Health First, it is important that the following steps are taken to make sure the HMO processes your claim correctly with the changes (failure to follow these steps will cause your claim to deny as a duplicate, even if all of the corrections warrant additional payment):

-Indicate that this is a CORRECTED CLAIM

-Confirm that the resubmission indicator is “7” for a corrected bill

-Reference the claim number of the initial denial from the managed care plan