Billing and Coding: Routine Foot Care

The information in this article contains billing, coding or other guidelines
that complement the Local Coverage Determination (LCD) for Routine Foot Care
L37643.

**Coding for Mycotic Nails**

Although CPT coding does not exclusively apply CPT codes 11720 and 11721 to
mycotic nails or to the feet, Medicare assumes these are the CPT codes
usually used to code for services related to debriding mycotic nails.

Assuming services are being provided based on this indication, and the above
requirements are documented, the claim should be coded with **ICD-10-CM code
B35.1 as a primary code AND L02.611- L02.612, L03.031-L03.032,
L03.041-L03.042, M79.671- M79.672, M79.674-M79.675 or R26.2** **as a secondary
code**. Systemic condition modifiers are not necessary for services performed
for this indication with these diagnosis codes.

The nail debridement procedure codes (11720-11721) are considered noncovered
routine foot care when these services do not meet the guidelines outlined
above for mycotic nail services or are not based on the presence of a systemic
condition. If the nail debridement procedures are performed in the absence of
mycotic nails and as part of foot care, they must meet the same criteria as
all other routine foot care services to be considered for payment.

**Coding for Systemic Conditions**

Foot care services are covered in the presence of certain conditions described
in the CMS Internet-Only Manual, Pub 100-02, Medicare Benefit Policy Manual,
Chapter 15, 290 identified by the following ICD-10-CM codes:

**Diabetes mellitus***  
  
E08.00-E13.9  
  
 **Arteriosclerosis obliterans** (A.S.O., arteriosclerosis of the extremities,
occlusive peripheral arteriosclerosis)  
  
I70.201-I70.92  
I73.00-I73.01  
I73.9  
  
 **Buerger 's disease (thromboangiitis obliterans)**  
  
I73.1  
  
 **Chronic thrombophlebitis***  
  
I80.00-I80.3  
  
 **Peripheral neuropathies involving the feet:**  
  

    * **Associated with malnutrition and vitamin deficiency***  
  
E56.9 and G63  
  

      * **Malnutrition (general, pellagra)***  
  
E46, E52, or E64.0 and G63  
  

      * **Alcoholism***  
  
G62.1  
  

      * **Malabsorption (celiac disease, tropical sprue)***  
  
K90.0 or K90.1 and G63  
  

      * **Pernicious Anemia***  
  
D51.0 and G63

    * **Associated with carcinoma***  
  
G13.0  
  

    * **Associated with diabetes mellitus***  
  
E08.40  
E08.42  
E09.40  
E09.42  
E10.40  
E10.42  
E11.40  
E11.42  
E13.40  
E13.42  
  

    * **Associated with drugs and toxins***  
  
G62.0  
G62.2  
G62.82  
  

    * **Associated with multiple sclerosis***  
  
G35 and G63  
  

    * **Associated with uremia (chronic renal disease)***  
  
N18.1-N18.9 and G63  
  

    * **Associated with traumatic injury**  
  
S86.001A-S86.009S  
S86.091A-S86.109S  
S86.191A-S86.201S  
S86.209A-S86.209S  
S86.291A-S86.309S  
S86.391A-S86.809S  
S86.891A-S86.909S  
S86.991A-S86.999S  
S89.80XA-S89.92XS  
S96.001A-S96.009S  
S96.091A-S96.109S  
S96.191A-S96.209S  
S96.291A-S96.809S  
S96.891A-S96.909S  
S96.991A-S96.999S  
S99.811A-S99.929S  
and G63  
  

    * **Associated with leprosy or neurosyphilis**  
  
A30.0-A30.9 and G63  
A52.10-A52.3 and G63  
  

    * **Associated with hereditary disorders**  
  
G60.0-G60.9  
  

      * **Heredity sensory radicular neuropathy**  
  
G60.0  
  

      * **Angiokeratoma corporis diffusum (Fabry's)**  
  
E75.21 and G63  
  

      * **Amyloid neuropathy**  
  
E85.0-E85.9 and G63

When the patient's condition is 1 of those designated by an asterisk (*)
above, routine procedures are covered only if the patient is under the active
care of a doctor of medicine or osteopathy or NPP who documents the condition.
This must be indicated by the name and national provider identifier (NPI) of
the attending physician in block 17 and 17B of the CMS-1500 or the equivalent
electronic claim format. The date the patient was last seen (DPLS) by the
attending physician should be billed in block 19. Claims for such routine
services should show the complicating systemic disease in block 21 of the
CMS-1500.

A presumption of coverage will be applied when the physician rendering the
routine foot care has identified:

      * 1 Class A finding using modifier Q7;
      * 2 Class B findings using modifier Q8; or
      * 1 Class B and 2 Class C findings using modifier Q9.

In addition to a valid billing indicator, these services must include a
systemic condition diagnosis listed above. All claims for routine foot care
based on the presence of a systemic condition should have a billing indicator
of Q7, Q8 or Q9 to be considered for payment.

Claims without a systemic diagnosis listed will be denied as non-covered
routine-type foot care services.

Services not meeting the instructions and criteria in this statement of
national coverage will be denied as statutory non-covered services. For
ICD-10-CM codes designated by an asterisk (*), we will require the DPLS and
the NPI of the doctor of medicine or osteopathy.