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Routine Toenail Trimming

  1. #1
    Location
    Louisville, KY
    Posts
    1,101
    Default Routine Toenail Trimming
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    I have racked my brain and exausted all leads on this one!

    There are patients who routinely present for nail care. Medically, there is nothing wrong with the patient's nails. In most cases, there is another reason the patient receives these services from podiatry; they range from being unable to reach his/her nails to having "poor eyesight" or the patient being advanced in age and simply not dexterous enough to do it on his/her own any longer.

    When these patient's present, what is the appropriate DX for the service? I could've sworn there was a V-code (back in the day) for routine nail trimming. However, I've come up empty handed.

    Any help would be appreciated!

  2. #2
    Default Routine nail care
    I wish there was a code for nails that just need to be trimmed, but the only codes I have been able to find are the ones for the Mycotic nail. Medicare and most private payers do not consider trimming nails to be medically necessary unless the patient has disease of the nail, such as onychomysis, and a systemic condition such as diabetes. Then if they meet this criteria we also have to have the Name, NPI number and the last date they saw their primary care physician.

    As you can see trimming the toenails is difficult if not impossible to get paid for. Unless you have the ability to get the patient to sign the ABN prior to the service being don.

    Evelyn Kim, MA, CPC

  3. #3
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Payment determination and whether it's a "billable" service is really not our determination. Basically, an ICD code is the issue.

    Thanks for your input. Anyone else?

  4. Default
    Hi,
    The current rule-

    ICD-9 Codes that Support Medical Necessity

    110.1*
    DERMATOPHYTOSIS OF NAIL
    681.10
    UNSPECIFIED CELLULITIS AND ABSCESS OF TOE
    681.11
    ONYCHIA AND PARONYCHIA OF TOE
    703.0
    INGROWING NAIL
    719.7
    DIFFICULTY IN WALKING
    729.5
    PAIN IN LIMB
    781.2
    ABNORMALITY OF GAIT

    *Note: ICD-9-CM code 110.1 must appear on each claim in addition to one of the other above ICD-9-CM codes that indicates secondary infection, pain, or difficulty in ambulation.

    Other related info-
    May be for patients with Diabetes mellitus accompanied by neuro manifestation(250.60) and cardiological sufferings(250.70) - payment can be considered more quickly.

    Suggestions for patients with conditions who may not be rendered the above ICDs-
    1. Neurological deficit, old age related. ICD - 781.99, may be.
    2. Poor vision - 369.9, can be given I think.

  5. #5
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Well, I'm thinking we should request a V-code for routine nail trimming. Although I'm very familiar with the codes payers consider medically necessary, those just are not appropriate for the cases I'm reviewing.

    As far as I'm concerned, that's a gap in I-9 that the industry should ask to be changed.

    Thanks everyone.

  6. Question Routine Foot Care
    I'm in the same boat as you. I took over our podiatry accounts last June and I'm still having issues. I think I got though. If the patient has a systemic disease, i.e. diabetes, routine foot care can be performed you must have the Q modifiers for Medicare and one of the diagnosis codes must be the diabetes code or any of the other codes that are on the Medicare website. Nail Trimming may be covered if the patient does not have a systemic disease but does have a fungus or mycotic nails. My issue is that I cannot for the life of me figure out where the G0127 comes into play. What do I bill that with? If anyone can help me on that one I would become their best friend because the routine foot care issue is going to drive me to the asylum. And don't forget your ABN's!
    Last edited by banderson77; 04-23-2009 at 01:32 PM.

  7. #7
    Location
    High Point, NC
    Posts
    84
    Smile
    G0127 is to used when you are trimming Dystrophic Nails. 11719 is for trimming of Non-dystrophic nails. The same coverage guidelines for Medicare apply to both codes. As far as a DX code, for routine nail trimming (non-covered), look at 703.8 - Hypertrophic nails - basically, long nails.

    Hope this is helpful.
    Cindy Gallimore, CPC, CENTC

  8. Default toenails
    if u have 8 dystrophic toenails and need to add 7o3.8
    do i do G0127 x 4, g0127 x 4, 703.8

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