Your CPT code is correct but the ICD-9 code is incorrect. If this is a Medicare caim you will to review your LCD policy for routine foot care. Example in the J5 MAC by WPS the dx 701.1 is not an eligable dx but 700 is. You will also need to include appropriate the diangosis to show patient has an systemic disease, such as metabolic, neurologic, or peripheral vascular disease, of sufficient severity that performance of such services by a nonprofessional person would put the patient at risk (for example, a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the patient’s legs or feet). Some diagnosis will also require to document the last time the patient was seen by the physician treating the systemic condistion such as diabetes. Clarification on this is document in the LCD policy on which diagnosis requires the last date seen with in the previous 6 mo of supervising physicia. Next you will need the appropriate Q modifier. This is decussed in the LCD policy. I have include the part of the LCD of J MAC for CPT 11055, 11056, 11057, 11719, and G0127:
Indications and Limitations of Coverage and/or Medical Necessity back to top
Routine foot care is the paring, cutting, or trimming of corns and calluses, or debridement and trimming of toenails in the absence of localized illness, injury or symptoms involving the foot. Routine foot care is usually performed by the beneficiary himself or herself, or by a caregiver.
Medicare allows payment for routine foot care only if the conditions under "Indications and Limitations of Coverage" are met. These conditions describe the systemic diseases and their peripheral complications that increase the danger for infection and injury if a non-professional provides these services.
NOTE
All claims submitted with CPT codes 11055, 11056, 11057, 11719, and G0127 must have modifier Q7, Q8, or Q9 and an ICD-9 code listed in this policy. If a claim is submitted without this it will be denied as not covered under the Medicare program.
The following services are considered to be components of routine foot care and are generally excluded from coverage under both Part A and Part B, regardless of the provider rendering the service:
• Cutting or removal of corns and calluses;
• Clipping, trimming, or debridement of nails,
• Shaving, paring, cutting or removal of keratoma, tyloma, and heloma;
• Non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage;
• Other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients;
• Any services performed in the absence of localized illness, injury, or symptoms involving the foot.
Indications:
While the Medicare program generally excludes routine foot care services from coverage, there are specific indications or exceptions under which there are program benefits.
1. Covered Routine Foot Care CPT codes 11055, 11056, 11057, 11719, and G0127, and 11720 - 11721.
Medicare payment may be made for routine foot care when the patient has a systemic disease, such as metabolic, neurologic, or peripheral vascular disease, of sufficient severity that performance of such services by a nonprofessional person would put the patient at risk (for example, a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the patient’s legs or feet).
Services normally considered routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds, or infections.
In evaluating whether the routine services can be reimbursed, a presumption of coverage may be made where the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement.
The following physical and clinical findings, which are indicative of severe peripheral involvement, must be documented and maintained in the patient record, in order for routine foot care services to be reimbursable
For purposes of applying this presumption the following findings are pertinent:
Class A findings
Non-traumatic amputation of foot or integral skeletal portion thereof
Class B findings
Absent posterior tibial pulse
Advanced trophic changes as evidenced by any three of the following:
1. hair growth (decrease or increase)
2. nail changes (thickening)
3. pigmentary changes (discoloring)
4. skin texture (thin, shiny)
5. skin color (rubor or redness)
Absent dorsalis pedis pulse
Class C findings
Claudication
Temperature changes (e.g., cold feet)
Edema
Paresthesias (abnormal spontaneous sensations in the feet)
Burning
The presumption of coverage may be applied when the physician rendering the routine foot care has identified:
1. A Class A finding (Modifier Q7)
2. Two of the Class B findings (Modifier Q8); or
3. One Class B and two Class C findings (Modifier Q9).
