Report Foot Care Based on Disease,Symptoms
Published on Wed May 01, 2002
Family practitioners (FPs) cut or pare keratotic lesions on feet and treat toenails because many of their patients with diabetes and other chronic conditions often have foot problems. Medicare considers cutting or paring of foot lesions and certain toenail treatments to be routine foot care a service not covered. But under certain circumstances, Medicare will reimburse for these services when they go beyond routine foot care. Note: If a significant, separately identifiable E/M is provided in addition to the foot-care procedure, you can code both procedures and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code. Also, if you think that the service may not be covered, have the patient sign a financial liability waiver (an advance beneficiary notice) to ensure that the practice can collect from the patient. Medicare does not cover routine foot care, which it defines as: the cutting or removal of corns or calluses the trimming, cutting, clipping or debriding of nails other hygienic and preventive maintenance care, such as cleaning and soaking of the feet or using skin creams to maintain skin tone any other service performed in the absence of localized illness, injury or symptoms involving feet. Code the Foot Lesion Based on System Condition and Class Findings Although CPT 11055-CPT 11057 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus] ...) describe the treatment of non-deep-seated keratotic lesions (e.g., a corn or callus), Medicare and some private payers will not reimburse for them. However, if the patient has specific risk factors, Medicare will cover this treatment. To be considered at risk, the patient must meet a systemic condition or have certain symptoms. The following list of systemic diseases is not all-inclusive but represents commonly billed diagnoses that qualify for routine foot care: Diabetes mellitus: 1. arteriosclerosis obliterans (440.9) (arteriosclerosis of the extremities [440.20] occlusive peripheral arteriosclerosis [440.9])
2. Buerger's disease (443.1) (thromboangiitis obliterans) Chronic thrombophlebitis (451.9) Peripheral neuropathies (356.x) involving the feet: 1. alcoholism (357.5) 2. associated with malnutrition and vitamin deficiency (269.9)
3. malabsorption (celiac disease [579.0], tropical sprue [579.1])
4. malnutrition (general, pellagra [265.2]) Pernicious anemia (281.0) associated with: 1. carcinoma 2. diabetes mellitus (250.xx)
3. drugs and toxins (284.8) 4. leprosy (030.x) or neurosyphilis (094.9)
5. multiple sclerosis (340)
6. traumatic injury
7. uremia (chronic renal disease) (585) Hereditary disorders: 1. amyloid neuropathy (277.3) 2. angiokeratoma corporis diffusum (Fabry's) (272.7)
3. hereditary sensory radicular neuropathy (356.2). Systemic disease qualifications vary among carriers. Ask your local carrier for its complete list.
To fulfill the coverage requirements for routine foot care, patients must also exhibit specific symptoms. Medicare divides the symptoms [...]
