“I am looking for a relatively concise explanation regarding Medicare’s policy on palliative care and coverage for diabetics and non-diabetics. As of late, fewer and fewer charges for nail debridement and keratosis debridement are being reimbursed. I have tried to search through Medicare’s guidelines but there is not enough time in a year to sift through the documentation. Is there such a thing as a concise explanation for Medicare’s guidelines for palliative care and CPT codes with ICD-10 codes?”
I wish that there was an abbreviated answer to this question or a quick way to access all of the information that is needed to appropriately address this issue. When a physician decides to participate with Medicare as a provider, a contract needs to be signed by the physician. One of the issues that is addressed is that by signing the contract, the physician agrees to follow the rules and regulations as stated by the Medicare Administrative Carrier. Most of the rules are presented in the form of Local Coverage Determinations (LCD) supplemented by associated articles regarding the proper coding and billing.
For a quick synopsis, you can access the Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, specifically Section 290 – Foot Care. Within this section is a brief explanation of Medicare’s guidelines for “At Risk,” Routine Foot Care and for the debridement of symptomatic mycotic nails. Unfortunately, it is a concise summary and all of the necessary information is not addressed including the appropriate ICD-10-CM diagnosis codes that need to be linked to the CPT codes that are billed.
I feel that it is imperative to go on the website of the Medicare Administrative Carrier in the state where you practice and access the LCDs for Routine Foot care and Nail Debridement if the carrier has both LCDs. I cannot address that issue without knowing the state in question.
First Coast Service Options is the Medicare Administrative Carrier for the state of Florida. This Medicare Administrative Carrier has an LCD for Routine Foot Care and also has an LCD for Nail Debridement. The LCD for Routine Foot Care is L33941 – Routine Foot Care. The associated article is A57188 – Billing and Coding: Routine Foot Care. The LCD for Nail Debridement is L33922 – Nail Debridement. The associated article is A57672 – Billing and Coding: Nail Debridement.
My suggestion is that you read the provided information over and go on the website of your Medicare Administrative Carrier and access the same LCDs, assuming that your Medicare Administrative Carrier does indeed have them. As I stated earlier, unfortunately there is not a short cut through the necessary information.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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