10/12/2021

Time Limitation for 11730, 10060 and 97597

Is there a limitation to how many times per year we can bill 11730, 10060 and 97597?

There is no set limit on how many times a provider can perform a nail avulsion, incision and drainage, or wound debridement on a patient. It is reasonable that these services may have to be repeated given a patient’s individual circumstances.

If the service is being repeated multiple times within a period of time, it increases the probability that the insurance will deny the charge for frequency based on guidelines not shared with providers about how many times it is reasonable to perform a minor procedure, or request supporting documentation to justify medical necessity.

If any of the surgical services are being done in considerable frequency, the documentation must clearly document the medical necessity and how alternative measures recommended by the provider at the time of service and aftercare have failed to provide relief to the patient that justify the recurring services.

If the notes do not support the need and no alternative therapies or medications are performed or recommended to the patient, then it leaves the door open for an insurance to recoup payments and potentially scrutinize future payments for the same condition.