Podiatry Coding & Billing Alert

Remember: Always include class findings.

Medicare’s routine foot care policy can be tricky to understand because although routine foot care is usually considered non-covered, sometimes this isn’t the case. For example, when your podiatrist removes corns and calluses, Medicare may consider it a covered service only if the circumstance falls under the specific exception to the rule.

Read on to learn more.

Myth 1: There Are no Exceptions for Routine Foot Care Coverage

Reality: Normally, Medicare will not cover routine foot care, which includes the cutting or removal of corns and calluses. However, as an exception to this rule, some systemic conditions may justify coverage.

“The presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease may require scrupulous foot care by a professional that in the absence of such condition(s) would be considered routine (and, therefore, excluded from coverage),” according to MLN Matters^® SE1113. “Accordingly, foot care that would otherwise be considered routine may be covered when systemic condition(s) result in severe circulatory embarrassment or areas of diminished sensation in the individual’s legs or feet.”

In those cases, specific foot care procedures that are normally considered routine, such as the cutting or removal of corns and calluses, could be unsafe if a nonprofessional person performs them on patients who have a systemic condition.

Underlying conditions that may justify coverage for routine foot care include but are not limited to diabetes mellitus (E08.00-E13.9), arteriosclerosis of native arteries (I70.201-I70.92), phlebitis and thrombophlebitis of lower extremities (I80.00-I80.9), abscess, cellulitis, and lymphangitis of the toe and foot.

Bottom line: The patient must have a covered diagnosis for the systemic condition or Medicare will not cover the corn and callus paring.

Myth 2: Active Care Doesn’t Matter

Reality: Some of the underlying conditions in Medicare’s coverage list are marked with an asterisk (*). This means that Medicare will only cover the procedure such as the paring of corns and calluses if the patient is under the active care of a doctor of medicine (MD) or a doctor of osteopathy (DO) who documents the condition.

For example, diabetes mellitus is one of the asterisked conditions, so an MD or DO would have to document the patient’s diabetes diagnosis and actively be taking care of the patient for Medicare to cover the corn and callus paring.

Myth 3: You Can Omit Class Findings

Reality: Class finding indications are a vital part of routine foot care and you must include them on your corn and callus paring claim.

When evaluating whether routine foot care services can be reimbursed, there is a presumption that the services may be covered with the evidence available of certain physical and or clinical findings. The physician must document and maintain the following findings in the patient’s record:

• Class A findings — “non-traumatic amputation” of the foot or integral part of the foot skeleton
• Class B findings — absent posterior tibial or dorsalis pedis pulse or three of the following: hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), and skin color (rubor or redness)
• Class C findings — edema, claudication, temperature changes, abnormal spontaneous sensations in the feet (paresthesia), and burning

Q modifiers: You should always use the proper Q code algorithm for routine foot care coverage. You should use modifier Q7 (One Class A finding) to indicate one Class A finding, modifier Q8 (Two Class B findings) to indicate two Class B findings, or the modifier Q9 (One Class B and Two Class C Findings) to indicate one Class B finding and two Class C findings.

Myth 4: Use Same Procedure Codes Regardless of Number of Corns Removed

Reality: CPT^® offers different codes for corn and callus removal based upon the number that your podiatrist removes.

Don’t miss: CPT^® considers corns and calluses to be “hyperkeratotic lesions,” so that’s what you will see in the code descriptor for those procedure codes.

Example: Your podiatrist uses a blade and local anesthesia to cut one corn off a patient’s left foot. You should report 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion) for this procedure because the code descriptor indicates that the podiatrist removed just one, single lesion.

On the other hand, if your podiatrist removes more than one corn or callus, you should turn to the following codes:

• 11056 (… 2 to 4 lesions)
• 11057 (…. more than 4 lesions)