No such thing as Routine Foot Care Asps surgical meeting Baltimore, Maryland September 11, 2015 Aaron Solomon, dpm, fasps Advanced foot care centers Chattanooga, Tennessee

Do not be chicken about routine foot care

Medicare is changing ICD-10 is here! Podiatric physicians need to be ready for this transition, but as if not more important Podiatric medical assistants ae ready for the transition One nof the most common and more difficult services to bill CPT will remain the same RAC audits

Standard codes of our lives 11719 11055 11056 11057 G0127 11720 11721

Services generally excluded from coverage regardless of the provider Cutting or removal of corns and calluses; Clipping, trimming, or debridement of nails, Shaving, paring, cutting or removal of keratoma, tyloma, and heloma; Non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; Other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients; Any services performed in the absence of localized illness, injury, or symptoms involving the foot. Taken directly from the Cahaba LCD

Exceptions to the Exclusions Necessary and integral part of otherwise covered services Treatment of warts on foot Presence of systemic conditions, such as metabolic, neurologic, or peripheral vascular disease Mycotic Nails In the presence of a systemic condition as noted above In the absence of systemic conditions: Ambulatory patient mut have marked limitation of ambulation, pain or secondary infection resulting from the thickening and dystrophy of infected toe nail plate. Non ambulatory patient suffers from pain or secondary infection from the thickening and dystrophy of infected toe nail plate

Foot Care Codes 11055 – Paring or cutting of benign hyperkeratotic lesion (corn or callus) single lesion 11056 – 2 to 4 lesions 11057 – more than 4 lesions 11719 – Trimming of nondystrophic (normal) nails, any number 11720 – Debridement of nail(s) by any method(s); 1-5 11721 – 6 or more G0127 – Trimming of dystrophic nails, any number

Most common scenario 11719 11055-57 Average payment now about $35-45 Add in G0127 and can increase substantially 11719 typically now only about $5

Don’t forget Go127: dystrophic nails Be careful with 11720-21-make sure there is documentation of a fungal infection $$$$CASH$$$$

Before treating the patient: Notify the patient that their foot care doesn’t meet the criteria for being covered by Medicare Establish a nail trimming private pay code (A9270 – noncovered item or service) that is not billed to insurance Consider utilizing an ABN

For covered routine foot care that requires date last seen by primary care physician Billed with appropriate Q modifier and date last seen by MD or DO for treatment or evaluation of the complicating disease during the 6 month period prior to the foot care service. (or 30 days after the service – **wink, wink) Q Modifiers determined by the Class Findings Combination of clinical findings that meet Medicare’s criteria for peripheral vascular disease. Coded with the 440.2_ series ICD-9 Diagnosis codes will change with ICD-10 The more you know about the new coding the more help you can be to your physician through this scary transition. So yo can ride off into the sunset of providing good AT RISK FOOT CARE

Class Findings Class A findings Class B Findings Class C findings Non traumatic amputation of foot or integral skeletal portion thereof Class B Findings Absent posterior tibial pulse; Advanced trophic changes as: hair growth (decrease or absence) nail changes (thickening) pigmentary changes (discoloration) skin texture (thin, shiny) skin color (rubor or redness) (Three required); and Absent dorsalis pedis pulse Class C findings Claudication Temperature changes (e.g., cold feet) Edema Paresthesias (abnormal spontaneous sensations in the feet) Burning

Summary Qx required along with DLS by PCP Or Note: See your Carriers LCD Corns & Callus 11055 OR 11056 11057 440.20 - ASO Qx required along with DLS by PCP Routine Foot Care + Nail Trimming Or 11719 OR G0127 250.60 or 250.70 + DLS by PCP Nail Debridement 11720 (1-5 Toes) Nail Debridement 110.1 + 729.5(pain in Limb) Or 440.20 11720 OR 11721 Mycotic Nails No special Issues

Coding Scenario: whaddya think? 99213 11719 11720 11056 29540 73630 All on the same day Anything missing?

Remember ICD 10 is HERE I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs B35.1 Tinea unguium L60.2 Onychogryphosis L60.3 Nail dystrophy L85.1 Acquired keratosis [keratoderma] Remember only applies to the diagnosis codes

Thanks!!