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Article Detail - JE Part B

Inappropriate Denials for Routine Foot Care Services - Resolved 09/15/21

Provider/Supplier Type(s) Impacted: Podiatrists, NPP, physicians

Reason Codes: N/A

Claim Coding Impact: 11055-11057 and 11720-11721

Description of Issue: An issue has been identified for clams billed with codes 11720-11721 for the treatment of mycotic nails and codes 11055-11057 for symptomatic hyperkeratosis for clams with date of service 07/12/21 and after. These codes are outlined in LCA: Billing and Coding: Routine Footcare and LCD: Treatment of Ulcers & Symptomatic Hyperkeratosis.

Noridian Action Required: Noridian will adjust any claims that are impacted and provide updates as they are available.

Provider/Supplier Action Required: Providers are encouraged to hold claims until system updates are completed.

Proposed Resolution/Solution: The claims processing system is being updated and a Noridian will complete a mass adjustment for claims denied incorrectly.

09/01/21 - System updates were completed. A mass adjustment for claims denied incorrectly will be completed. Further updates will be posted as they become available.

9/15/21 - Mass Adjustments have been initiated for claims denied incorrectly.

Date Reported: 08/11/21

Date Resolved: 09/15/21


            Last Updated Wed, 10 Nov 2021 19:10:07 +0000