Podiatry Coding & Billing Alert

Question: The doctor in our clinic trims almost every patient's nails upon consultation but only codes for this service occasionally. Is there any reason why we cannot code nail trimming every time the doctor performs this service?

Louisiana Subscriber

Answer: You cannot code for routine trimming of nails. CPT does not even include a code for this service since Medicare and most private payers do not consider this procedure medically necessary.

You can bill for nail trimming, however, if it is an essential medical procedure. Some examples of diagnoses that support medical necessity for nail trimming include:

• 110.1 -- Dematopytosis of nail

• 681.10 -- Unspecified cellulitis and abscess of toe

• 681.11 -- Onychia and paronchia of toe

• 703.0 -- Ingrowing nail

• 719.17 -- Difficulty in walking

• 729.5 -- Pain in limb

• 781.2 -- Abnormality of gait.

Bonus: Payers may also consider nail trimming medically necessary for patients with diabetes mellitus accompanied by neurological manifestations (250.60, Diabetes with neurological manifestations; type II or unspecified type, not stated as uncontrolled) and cardiological sufferings (250.70, Diabetes with peripheral circulatory disorders ...).

Tip: Ask your podiatrist to specify in his documentation the reason he performs a nail trim so that you can clearly identify when he is performing a medically necessary treatment that you can bill for.

If the patient does not present with any associated cellulitis, paronychia, or pain, your podiatrist must document "class findings" for you to bill the nail trimming. Append the appropriate modifier as follows:

• Q7 -- One Class A finding

• Q8 -- Two Class B findings

• Q9 -- One Class B and two Class C findings.