Wiki Podiatry Billing for Routine Footcare 11721

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browninge

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I am having trouble with the code 11721 getting paid by Medicare since ICD 10. Has anyone figured out how to get around this? We never had an issue with this code before ICD 10, but now we are getting denials stating that it is not "medically necessary. The dx codes we use are B35.1 as primary and M79.657 as secondary. If anyone has any insight on this code I would really appreciate the help!

Emily Browning, CPB
 
Most of the LCDs and NCDs have been updated with a list of covered DX for routine foot care. You cant just "get around this" The DX either meets medical necessity or it doesn't. Those DX codes listed are not Class A, B or C findings.

Routine foot care is payable when the patient has a systemic condition resulting in severe circulatory embarrassment or areas of desensitization in the legs or feet and the appropriate class findings are supported in the medical record and reported.
 
I don't think we've had a problem getting these paid. I know Noridian was denying CPTs 11055, 11056 and 11057 which are frequently billed with CPT 11721 due to an error in the LCD. They have since updated their LCD.

Remember, Medicare does not cover routine foot care unless, as CodingKing points out, a "systemic condition" exists. Those dx in and of themselves would not support medical necessity. If there are Class A, B or C findings documented then the appropriate Q modifier would need to be added to indicate medically necessity.
 
11721 and 11056 denials

I'm having the same problem. We are billing with E11.9 as primary and B35.1 or B35.1 and I83.93 which looks to be a covered sytemic condition.
 
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