“Can you evaluate and manage onychomycosis without debridement for the purpose of treating onychomycosis for an established patient? This would be in the absence of pain and underlying conditions, specifically with Medicare patients. Is it a covered condition for just evaluation and management? Would tinea pedis be covered as a sole diagnosis for evaluation and management?”
When a patient has onychomycosis and the affected toenails are debrided, it is specifically for two reasons.
Routine Foot Care Exception
1. Class Findings
2. Systemic Disease
3. Mycotic/Fungal Toenails
4. The Mycotic Toenails DO NOT Have
to be symptomatic
Otherwise Healthy Individual
1. No Class Findings
2. No Systemic Disease
3. Mycotic/Fungal Toenails
4. Symptomatology
If an established patient is seen for onychomycosis and the encounter/visit is to evaluate and manage the onychomycosis specifically for the purpose of treating the onychomycosis, this would certainly be a covered condition for an E/M service. Not only would the condition in question be “evaluated” so that a definitive diagnosis (ie. B35.1 – onychomycosis) could be made, but a treatment plan would also be put into effect. Options such as prescription oral medication, prescription topical medication, over the counter topical medication and a general treatment plan for onychomycosis (ie. patient instructed to keep the feet clean, patient instructed to dry between the toes, patient instructed to change the socks and hose daily, patient instructed to apply a topical antifungal medication to the affected nails on a regular basis, etc) would be discussed with the patient. This would have to be a free standing encounter. In other words, this onychomycosis specific visit could not be performed on the same date of service that one of the above encounters for the debridement of onychomycosis was performed. This is due to the fact that the E/M service that would be performed for the evaluation and management of the onychomycosis is directly related to the debridement of the mycotic toenails and would not be significant and separately identifiable.
Tinea pedis (B35.3) would certainly be covered as a sole diagnosis for evaluation and management. It is a dermatological issue that needs to be addressed more than likely with a prescription for a topical antifungal agent.
This is my opinion.
Michael G. Warshaw
DPM, CPC
THE 2021 Podiatry Coding Manual is available in either Book or Flashdrive formats. It has been completely updated including the E/M coding changes for 2021. Many offices across the country consider this to be their “Bible” when it comes to coding, billing and documentation. The price is only $125 including shipping! To purchase, access the website drmikethecoder.com.
Are you in compliance with Medicare concerning your billing, coding and documentation? An audit should never be more than an inconvenience. It should not be a life altering event. Find out your status before you are audited by your Medicare carrier. Drmikethecoder special: Have 5 dates of service audited for $250 (new clients only). Contact drmikethecoder.com for more information.
Read Comments