Wiki Medicare coverage for 11720

[LaVoncye]

Is there anyone out there who is familiar with the Medicare guidelines for debridement of Mycotic Nails? I have read the guidelines over and over but I am confused as to if Medicare will cover Debridement of nails for a patient which does not have a systemic condition but does meet the criteria when there is absence of a systemic condition for a ambulatory condition. Under LCD 27487. Or is the procedure 11720,11721 just covered for asystemic condition on the initial visit?

I'm so confused someone please help!!!!

Thanks

 

[jerome.randall.dpm@gmail.com]

Per the LCD...

" In the case of ambulatory patients there exist both:

Clinical evidence of mycosis of the toenail AND
Marked limitation of ambulation, pain, and/or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.

In the case of non-ambulatory patients there exist both:

Clinical evidence of mycosis of the toenail AND
The patient suffers from pain and/or secondary infection or the condition compromises the patient's ADL or care resulting from the thickening and dystrophy of the infected toenail plate."

I interpret this to mean it will be covered with correct ICD-9 coding. There must be documentation of pain along with mycotic nails ie 729.5 or 719.7 and 110.1. Ensure your provider has it documented in case Medicare pulls for review.

Hope that helps

Jerome R Randall Jr DPM CPC CPMA