Podiatry Coding & Billing Alert

Documenting diagnoses and findings can help you get deserved reimbursement.

Paring or cutting of corns and calluses are some of the most common services provided by podiatrists — but the fact that Medicare considers them part of “routine foot care” and won’t cover them sometimes proves problematic for coders and billers. However, there are instances in which you can receive fair reimbursement for CPT® codes 11055-11057 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]…). Read on for our experts’ advice.

Routine or Not?

Hyperkeratosis is the dead skin buildup that comes from repeated or prolonged pressure to the skin. Examples are corns (clavi) and calluses. 

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

According to Medicare’s “Foot Care Coverage Guidelines,” available at www.medicare.gov/coverage/foot-care.html, “Part B generally doesn’t cover routine foot care (like the cutting or removal of corns and calluses, the trimming, cutting, and clipping of nails, or hygienic or other preventive maintenance, including cleaning and soaking the feet).”

Part B carrier Palmetto GBA clarifies: “Claims for routine foot care are not covered when the coverage provisions for routine foot care are not met (i.e., there is no clinical evidence that the performance of these procedures by a non-professional would pose a hazard to a patient with a systemic disease that has resulted in severe circulatory embarrassment or areas of desensitization in the legs and feet).”

Translation: Unless the patient has a systemic condition that would make it dangerous for a non-professional to cut the corn or callus, Medicare (and private payers that follow Medicare guidelines) will not pay your podiatrist to do it.

Exceptions: “In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds or infections,” says Palmetto GBA.

Use Q Modifiers to Show Systemic Conditions 

There are dozens of ICD-9 codes that Medicare considers to show medical necessity for routine foot care, including corn and callus treatment. Check your local coverage determination (LCD) for specific codes, which will usually include codes from these series:

• 249.XX — Secondary diabetes mellitus
• 250.XX — Diabetes mellitus
• 356.X — Hereditary and idiopathic peripheral neuropathy
• 357.X — Inflammatory and toxic neuropathy
• 440.2X — Atherosclerosis of native arteries of the extremities
• 451.XX — Phlebitis and thrombophlebitis
• 585.X — Chronic renal failure.

Note: These codes are only examples of some covered diagnoses; this is not meant to be a complete list. Check your Medicare carrier’s LCD for specific codes.

To fulfill the coding requirements for routine foot care including 11055-11057, patients must also exhibit certain findings, which Medicare divides into three classes:

Class A findings:

• Non-traumatic amputation of foot or integral skeletal portion thereof.

Class B findings:

• Absent posterior tibial pulse
• Advanced trophic changes as evidenced by any three of the following:

             o hair growth (decrease or absence)
            o nail changes (thickening)
            o pigmentary changes (discoloration)
            o skin texture (thin, shiny)
            o skin color (rubor or redness)

• Absent dorsalis pedis pulse.

Class C findings: 

• Claudication (pain, discomfort or tiredness in the legs during walking)
• Temperature changes (e.g., cold feet)
• Edema
• Paresthesias (abnormal spontaneous sensations in the feet)
• Burning.

Podiatry coders can indicate class findings by appending one of the Q modifiers:

• Q7 — One Class A finding
• Q8 — Two Class B findings
• Q9 — One Class B and two Class C findings.

Put It All Together

Choose your corn or callus CPT® code depending on how many hyperkeratotic lesions the podiatrist treated:

• 11055 — Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion
• 11056 — …2 to 4 lesions
• 11057 — ...5 or more lesions.

Coding scenario: A diabetic patient presents with two calluses on her right foot. She complains of cold feet and pain in her calf. The podiatrist determines that the patient lacks a posterior tibial pulse. The podiatrist pares both lesions.

Solution: Code the appropriate-level office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient ...) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). The patient meets the systemic disease criteria for diabetes mellitus, as well as one Class B finding (absent posterior tibial pulse) and two Class C findings (claudication and temperature change). So you should report the paring as 11056 with modifier Q9 to indicate the documented class findings.

Also report diagnosis codes 700 (Corns and callosities) and 250.70 (Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled), says Arnold Beresh, DPM, CPC, CSFAC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. The patient has calluses and diabetes without mention of complication, type or instability.

ICD-10: When ICD-10 goes into effect on October 1, 2015, the diagnosis code will become L84 (Corns and callosities). 

Pitfall: Don’t double up on the codes just because the podiatrist cuts calluses on both feet — use the code that describes the total number of lesions on both feet. If the podiatrist pared one lesion on the left foot and one on the right, report one instance of 11056, not two instances of 11055.