1. 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

2. Do not be chicken about routine foot care

3. 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

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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

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

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

15. 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

16. Thanks!!