Wiki "Routine foot care"

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nbuck

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North Liberty, IA
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I'm wondering if you have any tips on how to get the procedure code 11055 (paring of a hyperkeratotic lesion, e.g. corn) paid for if the patient came in for foot pain and the provider diagnoses a corn and subsequently pares it. We have used the diagnosis 700 (corn) and are being denied stating that it's considered routine foot care. Thanks in advance.
 
bucksrus4 said:
I'm wondering if you have any tips on how to get the procedure code 11055 (paring of a hyperkeratotic lesion, e.g. corn) paid for if the patient came in for foot pain and the provider diagnoses a corn and subsequently pares it. We have used the diagnosis 700 (corn) and are being denied stating that it's considered routine foot care. Thanks in advance.
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Are they diabetic? If so, send a corrected claim listing the diabetes as the primary diagnosis, and 701.1 as the secondary diagnosis (if it's Medicare, I think you have to switch them and have 701.1 primary, but I'm not 100% sure on that).

If they're not diabetic, then it's routine foot care, and you should bill the patient. Hope that helps! ;)
 
They may qualify for class A, B, C findings, we put that modifier on our claims (if applicable) with the 701.1 and they get paid.
 
Foot Care LCD

bucksrus4 said:
I'm wondering if you have any tips on how to get the procedure code 11055 (paring of a hyperkeratotic lesion, e.g. corn) paid for if the patient came in for foot pain and the provider diagnoses a corn and subsequently pares it. We have used the diagnosis 700 (corn) and are being denied stating that it's considered routine foot care. Thanks in advance.
Click to expand...

Hi, I don't know where you're located, but here is a link to our Medicare LCD instructions showing which foot care procedures need to be linked to systemic diseases and the modifiers you must bill with them in order to be payable by Medicare.

Further down the page there is a link to the full LCD if you need it for your SOP.

http://www.wpsmedicare.com/part_b/education/routine_footcare.shtml
 
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