Help with Podiatry Coding-E&M-Routine Foot Care- Ingrown Toenail

[luvsgoofey]

Below is a note for a current service here in RI.
How would you code this?

Reason for Appointment 1. ingrown toenail, pt of RR History of Present Illness General/Constitutional: Patient seen for urgent visit with painful ingrown toenail to the right great toe for several weeks duration. Patient also complains of painful elongated nails and generalized foot pain. Denies any recent trauma. No other pedal complaints. Examination General Examination: General Appearance: alert in no distress. Peripheral pulses: Nonpalpable pedal pulses bilateral . Extremities: mild to moderate edema bilateral lower extremities. Musculoskeletal: no joint effusions, no joint erythema or warmth. Neurological: no gross sensory or motor deficit. Skin: Right Medial and lateral hallux nail with painful ingrown nail with underlying onychomycosis. No acute signs of infection. Elongated, thickened, yellow-brown discolored bilateral hallux and second digit nails with copious amounts of subungual debris. All other nails elongated and dystrophic. . Assessments 1. Onychomycosis - B35.1 (Primary) 2. Atherosclerosis of native artery of both lower extremities, with unspecified presence of clinical manifestation - I70.203 3. Onychogryphosis - L60.2 4. Pain of left foot - M79.672 5. Pain of right foot - M79.671 6. Ingrown toenail of right foot - L60.0 Treatment 1. Onychomycosis Notes: Educated to condition and treatment options Debridement of nails as noted. . 2. Atherosclerosis of native artery of both lower extremities, with unspecified presence of clinical manifestation Notes: Review proper PAD footcare with patient today Call with concerns, change in condition or questions Review higher level of care and ABI. 3. Onychogryphosis Notes: Debridement as noted. 4. Pain of left foot Notes: As noted with painful nails. 5. Pain of right foot Notes: As noted with painful nails As noted with ingrown toenail . 6. Ingrown toenail of right foot Notes: Patient educated to condition treatment options. Aseptic technique utilized to remove painful ingrown nail to the medial and lateral borders of the right foot utilizing nipper and curette. After care bacitracin and Band-Aid. Soaking instructions provided. We'll continue to follow. Call with concerns or change in condition Local anesthesia instilled prior to procedure . 7. Others Notes: Toenail Fungus: Care Instructions material was published to portal . Procedures Aseptic debridement of nails 1-5 b/l with nipper and burr. 30 % reduction performed. Procedure Codes Follow Up 2 Weeks

 

[fltbaroque]

I would bill an office visit with 25 modifier and 11721 for nail debridement. Is this a Medicare patient? If so, routine foot care is not payable unless certain requirements are met.

 

[SharonCollachi]

Medicare's footcare policy is here.

The documentation for the debridement for the onychomycosis does not meet the criteria for it to be covered, from the link: In the absence of a systemic condition, treatment of mycotic nails may be covered. The treatment of mycotic nails for an ambulatory patient is covered only when the physician attending the patient’s mycotic condition documents that (1) there is clinical evidence of mycosis of the toenail, and (2) the patient has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate. The treatment of mycotic nails for a non ambulatory patient is covered only when the physician attending the patient’s mycotic condition documents that (1) there is clinical evidence of mycosis of the toenail, and (2) the patient suffers from pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.

As far as the procedure to remove the ingrown toenail, look at 11730, 11732, 11750. I'm not clear from the documentation which one it would be.

If you didn't get an ABN, none of is billable to the patient, although the ingrown toenail treatment probably is covered.

 

[twalls]

Your I70.203 meets criteria for the debridement of nails as well as pain in the toes, then the B35.1. I would bill the E/M for ingrown- 25 and then the routine care for the nails.