Routine Foot Care Services and Podiatry Reimbursement

Routine Foot Care Services and Podiatry Reimbursement Routine foot care services may be covered by Medicare only if they are an integral part of otherwise covered services.

Along with treating complex foot conditions, podiatrists may have to provide routine foot care services. Medicare defines routine foot care as - the cutting or removal of corns or calluses, the trimming, cutting, clipping or debriding of nails as well as hygienic and preventive maintenance care such as - cleaning and soaking the feet, usage of skin creams to maintain skin tone of either ambulatory or bedfast patients and any other service performed in the absence of localized illness, injury or symptoms involving the foot. Medicare does not cover routine foot care services

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unless it is a necessary and integral part of otherwise covered services. Medical coding services for podiatry specialty involves reporting such foot care services based on the physician’s documentation and the concerned insurer’s coverage policies.

When Does Medicare Cover Routine Foot Care? 

If it is a part of other covered services

Medicare may cover routine foot care, if it is performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds or infections.

Often, payment is also made for incidental, non-covered services that are performed as a necessary and integral part of or secondary to a covered procedure. For instance, if toenails must be trimmed in order to apply a cast to a fractured foot, then the charge for the trimming of nails would be covered. 

In case of any systemic conditions

Routine foot care will also be covered, if the patient has any systemic conditions such as metabolic, neurologic or peripheral vascular disease that may lead to severe circulatory embarrassment or areas of lost sensation in the individual’s legs or feet.

Most common underlying conditions to justify coverage as exceptions to routine foot care exclusions are - Peripheral vascular conditions and diabetes, Diabetes mellitus, Arteriosclerosis obliterans, Buerger’s disease, Chronic thrombophlebitis, Peripheral neuropathies involving the feet, Malnutrition (general, pellagra), Alcoholism, Malabsorption (celiac disease, tropical sprue) and Pernicious anemia. In the case of systemic conditions, certain foot care procedures that otherwise are considered routine may pose risk when performed by a nonprofessional person on members with such systemic conditions. 

Mycotic nails treatment

In the case of an ambulatory patient, treatment of mycotic nails will be covered only if the physician’s documentation states that there is clinical evidence of mycosis of the toenail and the patient has marked limitation of ambulation, pain, or secondary infection.

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Documentation and Reporting of Foot Care All information about services performed must be documented accurately in the medical claims and records. 

In addition to a covered diagnosis, the class finding (signs and symptoms) of the underlying systemic disease must be documented in the patient’s medical records. Three class findings are 1 Class A finding (submit HCPCS modifier Q7) 2 Class B findings (submit HCPCS modifier Q8) 1 Class B and 2 Class C findings (submit HCPCS modifier Q9) Class A Finding – Non traumatic amputation of foot or integral skeletal portion thereof Class B Findings - Absent posterior tibial pulse, Absent dorsalis pedis pulse or Advanced trophic changes (at least three of - Decrease or absence of hair growth, Nail thickening, Skin discoloration, Thin and shiny skin texture or Rubor or redness of skin) Class C Findings – Claudication, Temperature changes (cold feet), Edema, Paresthesia (abnormal spontaneous sensations in feet) or Burning

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Report the appropriate procedure codes and modifiers for the service(s) performed.

CPT/HCPCS codes CPT codes that can be used to report routine foot care include o 11055 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion o 11056 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); 2 to 4 lesions

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o 11057 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than 4 lesions o 11719 Trimming of nondystrophic nails, any number o 11720 Debridement of nail(s) by any method(s); 1 to 5 o 11721 Debridement of nail(s) by any method(s); 6 or more HCPCS codes o S0390 Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit o G0127 Trimming of dystrophic nails, any number 

CPT modifier 59 is mostly used to allow separate reimbursement for services that would normally be “bundled” by the Correct Coding Initiative (CCI) edits. Before submitting this modifier, coders must verify whether the services are bundled through CCI.

Also, it is recommended to report foot/nail care with the applicable “Q” modifier. However, never report an E&M code when routine foot care or a nail trimming/debridement is the service actually performed. Practices can consider choosing an experienced medical billing and coding company to get their billing tasks done.

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