Scenario1 : NY medicare NEW patient office visit, 70 yr old man presents and just wants his feet evaluated and long toenails cut, no pain, no complaints. I'll do an evaluation and see 10 long thick mycotic nails, he does not have palpable pedal pulses, has absent hair and atrophic skin. I cut his nails in the office at that time, how should I bill? 99202 AND 11721 q8, or just 11721 q8? E/M pays more, am I to assume that if I just evaluated him and did nothing, I would get paid more by coding the E/M alone? I read where I'm not supposed to bill E/M in lieu of a procedure, but is it OK if I prescribe a topical antifungal and tell him to come back another day for his nails to be cut to be able to code the E/M on that day? I doubt a patient would ever come back if I sent him on his way without doing anything to his nails.

Scenario 2: Same patient comes back another day, wants his nails cut again, no pain, no complaints, same as scenario 1 above, subsequent visit. Would I bill 99211 and 11721 q8 or just the 11721 q8? (This situation I can understand that no E/M should be coded, just want to be sure, since I am indeed evaluating him again for the same issue)

Scenario 3: Another new first-time patient (for simplicity, presents with same single complaint of long thick nails), upon evaluation I see no pulses, no hair, atrophic skin, he does have long thick mycotic nails, but he also has an ulcer under his 1st mpj (patient unaware of it). I take care of his nails and debride his ulcer, non infected, clean wound base and teach him how to take care of it and tell him to follow up weekly. how would I bill this, 99202, 11721 and 97597? or just the procedures 11721 and 97597?