Article - Billing and Coding: Routine Foot Care (A57188)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Article TextThis Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33941 Routine Foot Care. Please refer to the LCD for reasonable and necessary requirements.Coding GuidanceNotice:It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.In order for routine foot care to be a covered service, the patient must have one or more of the diagnoses listed under the ICD-10 Codes that Support Medical Necessity section. Otherwise, the service is noncovered and should be coded with a GY modifier (Item or service statutorily excluded or does not meet the definition of any Medicare benefit).An evaluation and management visit will be paid on the same day as routine foot care only if the visit was medically necessary and was for a significant, separately identifiable service, and the modifier 25 is used.For the treatment of mycotic nails, please refer to the LCD L33922 Nail Debridement for indications and limitations.On all claims submitted by a podiatrist with ICD-10-CM diagnosis codes containing an asterisk on the tables below, the name of the M.D., D.O., or non-physician practitioner (PA or NP) who diagnosed the complicating condition must be submitted with the claim. The approximate date the beneficiary was last seen by the physician/ non-physician practitioner must also be indicated.On all claims submitted by a podiatrist with ICD-10-CM diagnosis codes with non-asterisked conditions, the name of the M.D., D.O., or non-physician practitioner (PA or NP) or the podiatrist who diagnosed the complicating condition must be on the claim form.For all providers submitting claims for routine foot care with ICD-10-CM diagnosis codes in the Group 2 Codes table below, the claims should use the appropriate modifiers (Q7, Q8, or Q9) to indicate the findings the provider has made on the patients condition.Q7 = One Class A findingsQ8 = Two Class B findingsQ9 = One Class B and two Class C findingsClass A FindingsNontraumatic amputation of foot or integral skeletal portion thereofClass B FindingsAbsent posterior tibial pulse, orAbsent dorsalis pedal pulse, orThree of the following advanced tropic changes are required to meet one class B finding:Hair growth (decrease or absence)Pigmentary changes (discoloration)Skin color (rubor and redness)Nail changes (thickening)Skin texture (thin, shiny)Class C FindingsClaudication (pain in calf when walking)Temperature changes in the feet (e.g., cold feet)EdemaParathesias (abnormal spontaneous sensations in the feet, e.g., tingling)BurningFor patients with peripheral neuropathy involving the feet but without vascular impairment, claims would be submitted without the Q7, Q8, or Q9 modifiers. Use the ICD-10-CM diagnosis codes in the Group 3 Codes table below.For patients requiring anticoagulation therapy, use the ICD-10-CM diagnosis codes in the Group 4 Codes table below.Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.When a Q7, Q8, or Q9 modifier is used, the provider must document in the medical record the appropriate signs and symptoms as outlined in Class Findings A, B, and/or C along with the complicating condition(s).When the patient has a systemic condition that might justify coverage and the services are performed by a podiatrist, the medical record must contain the name of the treating and/or diagnosing doctor of medicine or osteopathy.For diagnoses of peripheral neuropathy that do not require a Q modifier, and the presumption of coverage is based on loss of protective sensation, documentation must be available in the medical record of an absence of sensation at two or more sites out of five tested on either foot when tested with the 5.07 Semmes-Weinstein monofilament to support the diagnosis of peripheral neuropathy with loss of protective sensation. This test may be performed by the attending physician, non-physician practitioner, or the podiatrist.For patients requiring anticoagulation therapy, the provider must document in the medical record the significant risk and danger posed by the non-professional rendering routine foot care services.