Podiatry Coding and Billing

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Mycotic nails, ingrown toenails, blisters, corns, calluses, warts, bunions, nail infections, foot infections, heel pain, heel spur, flat feet, hammer toes, sprains, arthritis, foot injuries & etc. Also Podiatrist will treat bone fractures, wound care, ulcers, artery disease, amputations, foot prosthetics & etc.

Obesity, diabetes, arthritis, poor blood circulation, high cholesterol, heart disease & stroke.

Routine foot care is defined as:

(A)  The cutting or removal of corns or calluses.

(B)  The trimming, cutting, clipping or debriding of nails.

(C)  Hygienic and preventive maintenance care such as: Cleaning and soaking the feet.

Debridement of nails – 11720 & 11721

Trimming of non-dystrophic nails - 11719

Trimming of dystrophic nails – G0127

Paring of benign hyperkeratotic lesion – 11055, 11056 & 11057

It is inappropriate and incorrect to report an established E&M code when routine foot care or a nail trimming/debridement service is the service actually performed.

Medicare allows exceptions to this exclusion when medical conditions exist that place the beneficiary at increased risk of infection and/or injury if a non-professional would provide these services. The routine care CPT codes 11721, 11720, 11719, G0127, 11055, 11056 & 11057 are covered & should be billed with any one of the class modifiers (Q7, Q8 & Q9) to get paid.

Routine foot care may be covered when 'class findings' related to one or more of the preceding diagnoses are documented and the appropriate HCPCS modifier is submitted. Documentation must include (one of the following)

Q7: Modifier used when there is one Class A finding. 

Q8: Modifier used when there are two Class B findings. 

Q9: Modifier used when there is one Class B finding and two Class C findings.

Class A Finding

Non-traumatic amputation of foot or integral skeletal portion thereof

Class B Findings

Absent posterior tibial pulse

Absent dorsalis pedis pulse

Advanced trophic changes (at least three of the following):

• hair growth (decrease or absence)
• nail changes (thickening)
• pigmentary changes (discoloration)
• skin texture (thin, shiny)
• skin color (rubor or redness)

Class C Findings

• Claudication
• Temperature changes (cold feet)
• Edema
• Paresthesia (abnormal spontaneous sensations in feet)
• Burning

• Subcutaneous level – 11042 first 20 sq cm, report 11045 each additional 20 sq cm
• Muscle and/or fascia level - – 11043 first 20 sq cm, report 11046 each additional 20 sq cm
• Bone level – 11044 first 20 sq cm, report 11047 each additional 20 sq cm
• Skin level – 97597 first 20 sq cm, report 97598 each additional 20 sq cm
• Debridement of extensive eczematous or infected skin, CPT codes 11000 to 11012

CPT codes range 73600 to 73660.

26 - Professional Component - Certain procedures are a combination of a physician or other qualified health care professional component and a technical component. When the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.

TC - Technical component -  Under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier TC to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier TC; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles

DME includes, but is not limited to, wheelchairs (manual and electric), hospital beds, traction equipment, canes, crutches, walkers, kidney machines, ventilators, oxygen, monitors & etc.

Orthotics a foot pad or heel insert purchased at your local pharmacy or sporting goods store is an orthotic device. So is a custom-molded, individually designed shoe insert or ankle brace. Orthotic devices like these are frequently used to treat various conditions of the foot and ankle.

CPT code 11721 (Covered Nail Debridement 6 or more) requires class modifier (for routine check-up) with systemic conditions which is medically necessary to be reimbursed by Medicare but only six times in a year.