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
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