Noridian callus 11055-11057 denials

kelkin

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Hi- I wonder if Noridian is denying callus procedures inappropriately. The Routine Foot Care Policy has been 'retired' but the Noridian webinars tell us to continue to use it. The only active LCD for 11055-11057 is for Treatment of Ulcers & Symptomatic Hyperkeratoses and that states a patient has to have pain or cellulitis. What about the patient that has neuropathy and cannot feel pain? And at the very end of that LCD, it states "CPT/HCPCS Codes 11055, 11056, 11057, G0127, 11719, 11720, and 11721 may be used to provide routine footcare. Claims for those procedures will be allowed under the routine foot care benefit when the claims include the appropriate diagnoses and modifiers." In the past, our callus procedures (11055-11057) have been paid for patients with diabetic neuropathy- many of these patients have loss of sensation in their feet. Even the Medicare Podiatry Services Fact Sheet, that Noridian continues to post of their website, states "The presence of a systemic condition, such as metabolic, neurologic, or peripheral vascular disease, may require specialized foot care by a professional that, in the absence of such condition(s), would be considered routine (and, therefore, excluded from coverage).
Accordingly, routine foot care may be covered when systemic condition(s) result in severe circulatory embarrassment or areas of diminished sensation in the patient’s legs or feet. In these instances, certain foot care procedures that are otherwise considered routine (e.g., cutting or removing corns and calluses, or trimming, cutting, clipping,or debriding nails) may pose a hazard when performed by a non-professional on patients with such systemic conditions."

When I contacted a Noridian rep, I was told to continue billing as I had been in the past. Arrgghh! Anyone have answers? Thanks in advance!
 
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Hello We are having the same issues and using Modifier Q7, Q8 to explain the systemic conditions. How are others handling these, how are they coding? thank you
 
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