Podiatry Coding & Billing Alert

Remember: Don’t forget the importance of identifying class findings.

Corns and callous are usually considered a non-covered service that falls under Medicare’s routine foot care policy, according to Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

However, Medicare will cover routine foot care, such as the cutting or removal of corns and calluses, when systemic conditions result in severe circulatory embarrassment or areas of diminished sensation in the patient’s legs or feet. Under those conditions, foot care that is otherwise considered routine may be deemed as reasonable and medically necessary.

So, if your podiatrist pares corns for a patient who has a covered diagnosis such as diabetes E10.9 (Type 1 diabetes mellitus without complications), you should be able to receive payment for the corn paring service.

Read on to learn all you need to know about reporting corns and calluses to keep your claims in tip-top shape.

Covered Diagnosis Required for Systemic Conditions

Metabolic, neurologic, or peripheral vascular disease are example of systemic conditions that may warrant coverage for routine foot care. These conditions include but are not limited to diabetes mellitus (E08.00-E13.9), arteriosclerosis of native arteries (I70.201-I70.92), phlebitis and thrombophlebitis of lower extremities (I80.00-I80.9), abscess, cellulitis, and lymphangitis of the toe and foot.

Caution: If there is no covered diagnosis for the systemic condition, you will not receive coverage for the corn and callus paring.

The Medicare Benefit Policy Manual includes a list of various systemic conditions that may justify coverage for routine foot care. The manual tells you to pay attention to the conditions in the list that are marked by asterisks because with those diseases, routine foot care will only be covered if the patient is under the active care of a physician who documents the patient’s condition.

Decipher Specific Terms Used in Corn, Callus Medical Documentation

You may see the terms corn, callosities, clavus, and callus in your podiatrist’s medical documentation.

Callus and clavus are actually covered diagnoses under the ICD-10 corn and callus code — L84 (Corns and callosities).

Corn defined: A corn is a small, horny area of the skin caused by local pressure such as a shoe (irritating the tissue over a bony prominence. Corns usually occur on a toe, where they form “hard corns.” Between the toes, pressure can form a soft corn of macerated skin, which often yellows.

Callus defined: A callus is localized thickening and enlargement of the horny layer of the skin due to pressure or friction.

Corns or calluses are examples of benign hyperkeratotic lesions. Hyperkeratotic lesions are defined as dead skin that builds up from repeated or prolonged pressure to the skin.

Podiatrists may use other terms such as clavi, keratosis, hyperkeratosis, callosity, or durum to indicate corns and calluses.

Don’t Forget Importance of Class Findings

When evaluating whether routine foot care services can be reimbursed, there is a presumption that the services may be covered with the evidence available of certain physical and or clinical findings.

The following findings must be documented and maintained in the patient’s record:

• Class A findings — “non-traumatic amputation” of the foot or integral part of the foot skeleton.
• Class B findings — absent posterior tibial or dorsalis pedis pulse or three of the following: hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), and skin color (rubor or redness).
• Class C findings — edema, claudication, temperature changes, abnormal spontaneous sensations in the feet (paresthesia), and burning.

Modifier Alert: Don’t forget to use the proper Q code algorithm for coverage, Beresh explains.

You must use the Q7 modifier to indicate one Class A finding, the Q8 modifier to indicate two Class B findings, or the Q9 modifier to indicate one Class B finding and two Class C findings.

Verify Number of Corns Podiatrist Removed

To remove a benign hyperkeratotic lesion, the podiatrist may use a scalpel, curette, blade, or a spoon-shaped surgical instrument to reduce the lesion. He may also use local anesthesia.

You should choose the correct corn or callus CPT^® code depending on how many hyperkeratotic lesions the podiatrist treated:

• 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion)
• 11056 (… 2 to 4 lesions)
• 11057 (…. more than 4 lesions).