Medicare and Podiatry Claims
We have an issue at one of our clinics that I would like imput on, please.
Medicare patients are coming in to the practice in order to have his or her toenails trimmed. The coders are coding this with the diabetes codes. They tell me that they were told to code diabetes on the claims in order for this procedure to be paid. There is no mention of diabetes in the dictation from the provider and it certainly is not addressed, but Medicare denies this service unless diabetes is the diagnosis.
My concern here is pretty obvious. They are coding for the sole purpose of getting paid. I feel that the diagnosis should be whatever the reason is that the patient needs his or her toenails trimmed for and if Medicare denies the claim as noncovered, then this is the patient's responsibility.
My questions are:
1. What is the correct guidelines from Medicare regarding podiatry and toenail trimmings? Are they to be using DM as the diagnosis? Have I missed something?
2. Can anyone point me in the right direction of the Medicare guidelines for podiatry and toenail trimmings?
Last edited by dballard2004; 09-02-2008 at 10:15 AM.
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P