Podiatry Coding & Billing Alert

Question: If a patient has neuropathy from chemotherapy, but is not a diabetic and does not meet class findings (Q7, Q8 or Q9), is the patient covered under Medicare for routine nail care? I looked in the routine foot care LCD, but the language is unclear.

Ohio subscriber 

Answer: Ohio LCD says the patient must have class findings to be covered for routine foot care. However, directly under that it says, Benefits for routine foot care are also available for patients with peripheral neuropathy involving the feet, but without the vascular impairment outlined in Class B findings. The neuropathy should be of such severity that care by a non-professional person would put the patient at risk. If the patient has evidence of neuropathy but no vascular impairment, the use of class findings modifiers is not necessary. This condition would be represented by the ICD-10-CM codes in the 3rd table of “ICD-10 Codes that Support Medical Necessity” listed below.

In the codes that are listed below, one of the options is G62.0 (Drug-induced polyneuropathy) which would be the appropriate code for neuropathy from chemotherapy. This indicates that the patient you are asking about should be covered for routine foot care with a qualifying diagnosis of G62.0 even in the absence of class findings. You should document the nature of their neuropathy and that having this done by someone other than a podiatrist would place this patient at risk.

Finally, be aware that G62.0 has the instruction to “Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5).” You should include that if you know the drug.