Article - Billing and Coding: Routine Foot Care (A56680)

CMS National Coverage PolicyTitle XVIII of the Social Security Act, 1833(e) states that no payment shall be made to any provider for any claim which lacks the necessary information to process the claim.CMS Internet-Only Manual, Pub. 100-02,Medicare Benefit Policy Manual, Chapter 15, 290 Foot CareArticle TextThe 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 NailsAlthough CPTcoding does not exclusively apply CPTcodes 11720 and 11721 to mycotic nails or to the feet, Medicare assumes these are the CPTcodes 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 withICD-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 R26.2as 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 ConditionsFoot 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-E13.9Arteriosclerosis obliterans(A.S.O., arteriosclerosis of the extremities, occlusive peripheral arteriosclerosis)I70.201-I70.92I73.00-I73.01I73.9Buergers disease (thromboangiitis obliterans)I73.1Chronic thrombophlebitis*I80.00-I80.3Peripheral neuropathies involving the feet:Associated with malnutrition and vitamin deficiency*E56.9 and G63Malnutrition (general, pellagra)*E46, E52, or E64.0 and G63Alcoholism*G62.1Malabsorption (celiac disease, tropical sprue)*K90.0 or K90.1 and G63Pernicious Anemia*D51.0 and G63Associated with carcinoma*G13.0Associated with diabetes mellitus*E08.40E08.42E09.40E09.42E10.40E10.42E11.40E11.42E13.40E13.42Associated with drugs and toxins*G62.0G62.2G62.82Associated with multiple sclerosis*G35 and G63Associated with uremia (chronic renal disease)*N18.1-N18.9 and G63Associated with traumatic injuryS86.001A-S86.009SS86.091A-S86.109SS86.191A-S86.201SS86.209A-S86.209SS86.291A-S86.309SS86.391A-S86.809SS86.891A-S86.909SS86.991A-S86.999SS89.80XA-S89.92XSS96.001A-S96.009SS96.091A-S96.109SS96.191A-S96.209SS96.291A-S96.809SS96.891A-S96.909SS96.991A-S96.999SS99.811A-S99.929Sand G63Associated with leprosy or neurosyphilisA30.0-A30.9 and G63A52.10-A52.3 and G63Associated with hereditary disordersG60.0-G60.9Heredity sensory radicular neuropathyG60.0Angiokeratoma corporis diffusum (Fabry's)E75.21 and G63Amyloid neuropathyE85.0-E85.9 and G63When the patients 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 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; or1 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.