Podiatry Coding & Billing Alert

Question: Our podiatrist treats many nursing home patients. One has foot pain and all her nails are mycotic, but her nails are not painful. How can we report our physician's services for this patient when she doesn't have nail pain or any systemic disease to give class findings?

Florida Subscriber

Answer: Check your local carrier's guidelines because some (such as WPS Medicare) state that "In the absence of a systemic condition, treatment of mycotic nails may be covered." The patient might experience pain but it isn't always a requirement for coverage, especially if the patient has secondary infection or other complications. If you do report the treatment, submit 11721 (Debridement of nail[s] by any method[s]; 6 or more).

One idea: Some physicians might treat the patient once without billing the care if the patient has no qualifications. Then they let the nursing home staff know they will only treat the patient in the future if the nursing home covers the service (unless the patient's condition changes and insurance will reimburse the physician). Coders who go this route say the nursing home often agrees to pay for the service.