Podiatry Coding & Billing Alert

Question: Our podiatrist recently attended to a patient who had diabetes with neurological manifestation, dermatophytosis of nail, and pain in limb. The physician performed the following services: 

1. Nail debridement (6 nails)

2. Trim skin lesion (1 on the left foot and 3 on the right)

How should I code this encounter? 

Missouri Subscriber

Answer: Based on the information you have provided, you should code 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:…) for the office visit as your patient seems to be established. Generally, a patient is considered to be “established” if the same physician, or any physician in the group practice (or, to be more precise, any physician of the same specialty billing under the same group number), has seen that patient for a face-to-face service within the past 36 months. You will have to attach modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to demonstrate that the patient had initially come for a consultation and the podiatrist ordered the services as a consequence of the E/M visit.

Beware: You will not be able to report the E/M if the patient’s express purpose of visiting the clinic was to get the services.

For the nail debridement, you can report 11721 (Debridement of nail[s] by any method[s]; 6 or more). Attach modifier Q7 (One class a finding) because CMS guidelines require that when you are reporting foot/nail care, other than routine care that isn’t medically necessary, you need to include the applicable “Q” modifier. 

For the lesion trimming, you should report 11056 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; 2 to 4 lesions) with modifier 59 (Distinct procedural service).