Podiatry Coding & Billing Alert

Question: During his initial visit, a new diabetic patient (250.7x) complaining of foot pain had his feet examined. The podiatrist removed a callus from his right foot. The patient was shown to have onychomycosis, so the doctor debrided two nails on the left foot (TA and T1). The E/M code is 99203. How should I code this? Should I use modifier 25?

Oklahoma Subscriber

Answer: Yes, you use modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). You would attach modifier 25 to E/M code 99203 (Office or other outpatient visit...), which you should link to 729.5 (Pain in limb) and 250.7x (Diabetes with peripheral circulatory disorders).

For the procedures, if billing Medicare, you will need to include the class findings Q7 (One class A finding), Q8 (Two class B findings), or Q9 (One class B and two class C findings). These class findings need to go before the LT and RT modifiers.

For the callus removal, use 11055 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion) and link it to diagnosis code 700 (Corns and callosities). For the nail debridement, use 11720 (Debridement of nail[s] by any method[s]; one to five) linked to 110.1 (Onychomycosis).

Report the codes in this order:

• 99203-25
• 11055-Qx-RT
• 11720-Qx-LT.

The toe modifiers TA (Left foot, great toe) and T1 (Left foot, second digit) are not included in the nail debridement. This is because up to five nails are covered by 11720. You could include the T modifiers if you wish to be more specific to the carrier.