I'm confused about the procedure with the codes 11055 and 11721. I understand they need a Q7/Q8/Q9 modifier with it. However--- I'm confused as to if it doesnt qualify under those modifiers, what codes to use. Right now i'm just pushing it back to a 99212/99213 code. AM I doing the right thing?
You need to report the procedure you are doing, if the provider is doing a pairing or cutting you must report that code. If there is not a diagnosis or condition that justifies the care (or does not qualify under the Q Modifiers), the provider would still report the treatment using the correct codes, however, you will need to have an ABN on File- and let the customer know it may not be a covered procedure. I would suggest referring to your local LCD - If you are a Find-A-Code subscriber there are a lot of tips on using these codes. You can also sign up for a FREE trial by going to Findacode.com. I can only say this because they are Codapedias sister company.