02/22/2021

Correct Coding for Parkinson’s Patient for RFC with Calluses

Pt with Parkinson's tremors comes for routine foot care with calluses. I billed 11056 with Q9 modifier and its denied. They paid for 11720 and 11719.

CPT code 11056 was denied correctly by Medicare for medical necessity. According to the current coding article from NGS, coverage of routine foot care procedures, Parkinson’s Disease is not considered a covered diagnosis. If the patient does not have another systemic condition that would justify routine foot care (such as diabetes, PVD, ASO), then it will not be covered. In the future, if the patient presents to the practice for routine foot care, it is suggested that an ABN be obtained for this service so the patient can be billed for the non-covered service, or that the service can be billed to their secondary insurance for payment (if applicable).