Podiatry Coding & Billing Alert

Hint: Study the new bunion codes.

Think you made an A+ on the podiatry coding quiz on page 43? Test your knowledge and check your answers against our experts’.

Answer 1: True. Medicare does not cover services it refers to as “routine foot care” unless the podiatrist performs them along with certain vascular, metabolic, or neurologic diseases (like celiac disease or malnutrition).

The routine foot care services not covered are as follows:

• Cutting or removal of corns and calluses.
• Clipping, trimming, or debridement of nails.
• Shaving, paring, cutting, or removal of keratoma, tyloma, and heloma.
• Non-definitive simple, palliative treatments like shaving or paring of plantar warts, which do not require thermal or chemical cautery and curettage.
• Other hygienic and preventive maintenance care in the realm of self-care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients.
• Any services performed in the absence of localized illness, injury, or symptoms involving the foot.

Answer 2: CPT^® 2017 added new bunion codes 28291 (Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant) and 28295 (Correction, hallux valgus [bunionectomy], with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method).

Revision: CPT^® 2017 revised the following bunion codes:

• 28289, Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant
• 28292-28299, Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed …

Deletion: CPT^® 2017 deleted the following CPT^®  codes:

• 28290, Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (e.g., silver type procedure)
• 28293, … resection of joint with implant
• 28294, … with tendon transplants (e.g., joplin type procedure).

Answer 3: Medicare generally doesn’t cover treatment for flat feet. But, although carriers often do not reimburse for treatment of acquired flat feet, oftentimes they will if it’s congenital.

Important: There’s no bilateral code, so in the presence of both, report each separately. Your code choices are as follows:

• Q66.51, Congenital pes planus, right foot
• Q66.52 (Congenital pes planus, left foot
• M21.41, Flat foot [pes planus] (acquired), right foot
• M21.42, Flat foot [pes planus] (acquired), left foot.