Podiatry Coding Modifiers: Exceptions and Exclusions (Part 2)

In my last post here I commented on specific podiatry coding guidelines such as class findings, billing instructions, required claim information, and adequate documentation. Modifiers play a large role in coding, with the most important rule being: sequence the “payable” modifier first. Because podiatry typically uses more than one modifier, it’s important to remember this.

Podiatry Coding Modifiers: Exceptions and Exclusions

You were provided with the “exceptions” list for billing routine foot care and websites to follow for additional information. Medicare also has an “exclusions” list which means these services are considered routine and not medically necessary resulting in non-payment.

The exclusions are: (1) The cutting and- removal of corns and calluses; (2) The cutting, trimming, clipping, or debriding of nails; (3) Hygienic and preventive maintenance such as soaking and cleaning the feet or application of skin creams to sustain skin tone. Any service performed on a patient where there is no sign or symptom of illness to the foot is considered uncovered.

There is a list of diagnosis codes you can find on the Medicare website: http://cms.hhs.gov.mcd where asterisked and non-asterisked diagnosis codes such as 250.60* to 250.63* or 030.0 to 030.3 to site a few, will help you code foot care. Remember: Foot care is considered routine unless the patient has a secondary diagnosis of a systemic disease and is under the active care of a doctor.

This diagnosis list will guide you in determining the covered and non-covered foot care services that fall in the CPT/HCPCs categories:
11055 Paring or cutting of benign hyperkeratotic lesion (corn/callus); single lesion
11056 ; 2 to 4 lesions
11057 : more than 4 lesions
11719 Trimming of non-dystrophic nails, any number
11720 Debridement of nail(s) by any method; 1to 5
11721 ; 6 or more
11730 Avulsion of nail plate, partial or complete, simple; single
11732 ; each additional nail plate (List separately in addition to code for primary procedure)
G0127 Trimming of dystrophic nail(s)

Always follow Medicare’s Local Coverage Determinations. Know the Place of Service (POS) rules for DME products, procedures such as 11043 (debridement, muscle, and/or fascia [includes epidermis, dermis, and subcutaneous tissue; first 20 sq cm or less) and codes such as 17110 (destruction of benign lesions other than skins tags or cutaneous vascular proliferative lesions, up to 14 lesions). Global periods will also range from 0 to 90 days.

Strapping codes such as 29540 to 29580 can sometimes be bilateral; be sure to use LT and RT instead of modifier 50 and always check private payer rules.

When billing orthotics to Medicare, claims must include modifier KX if all medical necessity supporting documentation is on file, followed by “RT” or “LT”. Examples of such HCPCs codes would be L4386- CAM Walker or L4396- Night Splint. Location code would be 12: Home or 32: Nursing Facility. “NU” (New Equipment) modifier would be used for crutches, canes, or walkers. Use an ABN (Advanced Beneficiary Notice) when needed and add “GY” for non-covered items.

Include a date of injury if applicable. Medicare claims for DME are not sent to regular Medicare but to the DME regional carrier. Use the CMS-1500 form. Other payers will accept physician and DME at the same address but again, double check. Podiatrists provide different levels of service to patients but Medicare and other payers will give you the specific coding information you need. I am offering a sampling of the most common coding scenarios in order to grasp certain requirements.

Next up: Part III of Podiatry Coding and Billing will cover specific coding rules on therapeutic shoes and inserts as well as claim form preparation.

Related Podiatry Coding Content:

Podiatry Coding Part-2

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