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Routine Foot Care

Routine Foot Care: A Lot of the Same
Coding

Routine Foot Care: A Lot of the Same

by Michael Warshaw, DPM, CPC

“I am a young physician and the practice that I am currently at codes almost all routine foot care patients as the following: 1. Tinea ungium B35.1, 2. Peripheral Vascular Disease (PVD) I73.9, 3. Pain in left toe. Documentation is all the same: “All nails are thickened, discolored, and painful with subungual debris” with CPT 11721. Basically, there is no individual nail documentation and all nails are always painful with PVD. This includes younger, disabled patients who present with some thickened nails. I was under the impression that you have to document individual nails and that pain alone is a qualifying diagnosis for nails, if used as the secondary code. My question is: wouldn’t coding only CPT 11721, with pain and PVD to all toes all the time raise red flags?”
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Coding

Mycotic Nail Debridement in the Otherwise Healthy Individual

by Michael Warshaw, DPM, CPC

UNLESS THE FUNGUS INFECTION IN A NAIL REQUIRES DEBRIDEMENT BECAUSE IT CAUSED THE NAIL TO BE ABNORMALLY THICK WHICH RESULTED IN EITHER PAIN OR A SECONDARY INFECTION OR A MARKED LIMITATION OF WALKING, THE TREATMENT SERVICE IS CONSIDERED SIMPLY A NAIL TRIMMING AND IS NOT PAYABLE BY MEDICARE.
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Coding

Treatment of Diabetics with LOPS

by Michael Warshaw, DPM, CPC

Peripheral Neuropathy is the most common factor leading to amputation in people with diabetes. In diabetes, peripheral neuropathy is an anatomically diffuse process primarily affecting sensory and autonomic fibers.
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Coding

What is the Active Care Requirement regarding “At Risk, Routine Foot Care?

by Michael Warshaw, DPM, CPC

What is the Active Care Requirement regarding “At Risk, Routine Foot Care?
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Coding

Routine Foot Care: Cash Clinic

by Dr. Michael Warshaw, DPM, CPC

“I am in practice and would like to figure out a different way to contain and manage my routine foot care. It is approximately 15% of my practice. I would like to designate one morning a week as a routine foot care clinic. I am considering making this a cash only clinic: $50 for toenails and $50 for calluses. Is this possible? I am a Medicare provider and have contracts with most insurance companies. I was hoping to model my cash clinic on what some nurses in the area have done. They visit a nursing home and offer residents $25 for routine foot care and do not work with any insurance companies or Medicare. Any thoughts on this cash model, routine foot care clinic would be appreciated.”
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Coding

Wound Care Coding: Recurrent and Frequent Treatment

by Dr. Michael Warshaw, DPM, CPC

​​​​​​​“I have a Medicare patient that has healed a neuropathic ulcer (L97.522, E11.62) at the plantar base of his 5th metatarsal. He needs paring of the hyperkeratotic tissue, frequently with hemorrhagic changes, every four weeks or he re-ulcerates at this location. Should this be coded as: CPT 11055 using a GY modifier every other visit? Debriding devitalized tissue CPT 97597 or am I evaluating and managing an ulcer CPT 9921X?”
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Coding

Routine Foot Care: Peripheral Vascular Disease

by Dr. Michael Warshaw, DPM, CPC

“My practice involves a lot of routine foot care and I am looking for clarification. In using Q8 and Q9 modifiers, do you need to have atherosclerotic peripheral vascular disease (ASPVD) as a diagnosis? If so what’s the code to be used for general ASPVD? Modifier Q7 indicates that there has been an amputation. It is not necessary to have an ASPVD diagnosis in that scenario?”
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