Stay Compliant When Reporting Foot Care Claims
Question: When can a provider receive reimbursement for foot care? Our podiatrist performed the service for a Medicare patient with type 2 diabetes mellitus (DM) with neuropathy in the feet, but I’m not sure how to report the service. Vermont Subscriber Answer: Medicare has several requirements for foot care compliance. First, the payer covers routine foot care only when the procedure is medically necessary. This doesn’t include routine nail trimming, removing corns or calluses, or performing hygienic foot care, as these tasks are considered personal grooming. The coverage needs to be linked to a systemic condition, such as the diabetic neuropathy you mentioned. You’ll do this by adding a corresponding ICD-10-CM diagnosis code for the systemic condition. For the condition you’ve presented, assign E11.42 (Type 2 diabetes mellitus with diabetic polyneuropathy) to report the DM with neuropathy. Simultaneously, the podiatrist’s documentation needs to show why the service isn’t just hygienic. This is done by using Medicare’s Class Findings, which are clinical indicators to designate the service as medically necessary. The documentation needs to include this information, and you’ll append an appropriate Q modifier to the procedure code. By carrying out neuropathy tests, the podiatrist can prove the risk to the patient if care isn’t performed. For example, the neuropathy shows a reduction in a protective feeling meaning that the patient won’t be able to feel pain. Mike Shaughnessy, BA, CPC, Production Editor, AAPC
