G0127 and 11720 are two related procedures typically done during routine foot care, involving the trimming and debridement of nails. Patients who need one treatment done typically need the other as well, which leads to podiatrists billing both at the same time.
So can CPT G0127 and 11720 be billed together? Yes, there is nothing preventing a podiatrist from billing them as one. As long as the forms are done properly and error-free, with the conditions and clearly marked out, there should be no problem with billing the two treatments together.
What are G0127 and 11720?
As defined by the American Medical Association, Current Procedural Terminology (CPT) codes G0127 and 11720 are codes for procedures found under Surgical Procedures on the Nails.
Specifically, CPT G0127 refers to the trimming of any number of dystrophic nails. Dystrophic nails are nails that are suffering nail dystrophy, or the discoloration and distortion of the nail’s normal structure. Nail dystrophy is generally as a result of inflammatory or traumatic processes that affect the nail bed, nail matrix, and/or surrounding nail tissues. In adults, nail dystrophy is most often a result of dermatophyte fungal infection.
CPT 11720 refers to nail debridement, or the removal of the toenail bed, in 1-5 toenails (6 toenails or more fall under CPT 11721). The purpose of debridement is to remove excessive material or curvature from a clinically diseased or thickened dystrophic nail. Debridement reduces the bulk and thickness of the nail, allowing it to regrow normally again.
Tips for Billing G0127 and 11720
These procedures can be done at the same time – nail trimming focuses on reducing the length of the nail, while debridement focuses on reducing the bulk or thickness of the nail. So can CPT G0127 and CPT 11720 be billed together?
Yes, but it is important that the billing is properly done and recorded to ensure that it is not denied. When dealing with CPT 11719, 11720, 11721, and G0127, Medicare typically covers the procedures when they are done on “at-risk” patients, or patients who have systemic conditions.
Systemic conditions are defined as a neurological, peripheral vascular, or metabolic disease leading to severe circulatory embarrassment or desensitization in the feet or legs. Systemic conditions can include:
- Buerger’s disease
- Diabetes mellitus
- Vitamin deficiency
- Peripheral neuropathies of the foot
- Arteriosclerosis obliterans
If no system conditions are present, the patient must have mycotic nails involving severe symptoms and significant pain that prohibits them from trimming their nails safely on their own.
For CPT 11720 and 11721, Medicare coverage is possible in patients who do not have systemic conditions as long as they are proven to have painful dystrophic nails. To ensure that your bill is approved, make sure that there is a documented history and examination proving that the nails are causing severe pain. Q modifiers here are Q7, Q8, and Q9.
The documentation must objectively prove that the nails are limiting the patient’s ambulation or movement; simply writing the patient’s description of the pain is typically not sufficient for approval.
Finally, when billing G0127 and 11720 (or any other related procedures), ensure that the nail care procedures are aligned with nail ICD-9 codes and modifiers. Errors in billing can quickly result in billing denials. On the foot care claim form, clearly align painful conditions and at-risk conditions with their required ICD-9 codes and modifiers.
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