01/16/2019

Correct Billing for 11719

I have reviewed the LCD for G0127, but am still unclear as to when I can bill this code instead of 11719. Thank you.

According to the LCD policy and the definition of each CPT code, CPT 11719 should be billed when the patient does not have any documented dystrophy of the toenails; the G code should be billed when there is dystrophy documented with the nails. The code that is billed on the claim depends on the documentation for the routine foot care encounter- the trimming code would depend on whether the patient has dystrophy of the nails.

11719 (TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER)

G0127 (TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER)

Refer to our Routine Foot Care Quick Reference Guide located on the CPR Portal:

http://nyspma.org/aws/NYSPMA/asset_manager/get_file/118508?ver=55