Routine Foot Care and Wart Paring

A common coding question in dermatology concerns Medicare coverage of routine foot care. Medicare Part B does not cover routine foot care, unless it is part of a medically necessary treatment for a disease or condition, such as metabolic, neurologic, or peripheral vascular disease. In addition, the need must be severe enough that if such services are not provided, the patient would be at risk for disability as outlined below.

Common non-covered procedures for routine foot care are:

• cutting or removal of corns and calluses (11055-11057);

• clipping, trimming, or debridement of nails (11720-11721); or

• any services with the absence of localized illness, injury, or symptoms involving the foot or 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.

Services normally considered routine may be covered if they are performed as a necessary and integral part of an otherwise covered service, such as treatment of mycotic nails, treatment of ulcers, wounds, or infections. The class findings (outlined below) or the presence of qualifying systemic illnesses that cause peripheral neuropathy must be present.

The following physical and clinical findings must be documented and maintained in the patient record in order for routine foot-care services to be reimbursable. Presumption of coverage can be assumed only when the physician performing the routine foot care has identified one or more of the conditions listed below. The physician must identify the following to be appropriately reimbursed: (1) Class A finding (Q7); (2) two of the Class B findings (Q8); or (3) one Class B and two Class C findings, in addition to a primary condition (Q9).

Class A findings (Q7):

• Non-traumatic amputation of foot or integral skeletal portion thereof

Class B findings (Q8):

• Absent posterior tibial pulse

• Advanced trophic changes as evidenced by any three of the following:

  • hair growth (decrease or increase)

  • nail changes (thickening)

  • pigmentary changes (discoloring)

  • skin texture (thin, shiny)

  • skin color (rubor or redness)

• Absent dorsalis pedis pulse

Class C findings (Q9):

• Claudication

• Temperature changes (e.g., cold feet)

• Edema

• Paresthesias (abnormal spontaneous sensations in the feet)

• Burning

Another common coding question is regarding the treatment of warts on the feet. Warts on the feet are covered to the same extent as warts located elsewhere in the body. A common coding error is reporting Current Procedural Terminology (CPT^®) code 11055, Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion, for the destruction of warts. Paring a wart without cryosurgery or another method of benign lesion destruction would be included in an evaluation and management (E/M) service; therefore, it would not be appropriate to report code 11055.

Medicare requires that the documentation for these service to include the location of each lesion treated, identification (by number or name) of, and description of all nails treated. Medicare has also requested a description of the procedure beyond the simple term of “nail debrided.” In addition, the record needs to reflect the necessity of each service. The CMS-1500 claim form requires that the appropriate finger (FA-F9) and toe (TA-F9) modifier to be appended for reimbursement. For additional information, review Chapter 15 of the Medicare Benefit Policy Manual Publication 100-2, which is available at http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf.