Coding Podiatry Services
Podiatrists have to deal with various foot conditions - chronic or acute. Some services are not reimbursed. Most services related to the foot are based on medical necessity requirements and require the podiatrists to document their services as meticulous as possible. Specificity of ICD-10, CPT and HCPCS codes should be reported on claims to prevent denials and ensure appropriate reimbursement. Certain multiple procedure codes can be listed for one operative note, while some of them may be considered as part of the more complex procedures being performed. Careful review of all the codes recommended before choosing the final code(s) for the podiatry procedure would be prudent.
Podiatry Modifiers
Modifiers provide additional information to payers regarding the services provided. More than one modifier may be used with a single procedure code. Some modifiers can only be used with a particular category and some are not compatible with others.
T1 - T9 (Toe Modifiers) Do not use these modifiers for codes 11720 and 11721
When submitting claims for routine foot care with ICD-10 diagnosis codes in the “Group 2 Codes”, use modifiers (Q7, Q8, or Q9) to report findings the provider has made on the patient’s condition.
Q7 - One Class A findings
Q8 - Two Class B findings
Q9 - One Class B and two Class C findings
Class A findings
Nontraumatic amputation of foot or integral skeletal portion thereof
Class B findings
Absent posterior tibial pulse or
Absent dorsalis pedal pulse or
Three of the following advanced tropic changes are required to meet one class B finding
Hair growth (decrease or absence)
Pigmentary changes (discoloration)
Skin color (rubor and redness)
Nail changes (thickening)
Skin texture (thin, shiny)
Class C findings
Claudication (pain in calf when walking)
Temperature changes in feet (e.g. cold feet)
Edema
Parathesias (abnormal spontaneous sensations in the feet (e.g. tingling)
Burning
Podiatry CPT Codes
11055 Pairing or cutting of benign hyperkeratotic lesion ( eg corn or callus) single lesion
11056 Pairing or cutting of benign hyperkeratotic lesion (2 to 4 lesions)
11057 Pairing or cutting of benign hyperkeratotic lesion (more than 4 lesions)
11719 Trimming of nondystrophic nails, any number
11720 Trimming of nondystrophic nails, 1 to 5
11721 Debridement of nail(s) by any method; 6 or more
G0127 Trimming of dystrophic nails, any number
11730 Avulsion of nail plate, partial or complete, simple, single
11732 Avulsion of nail plate, partial or complete, simple, each additional nail plate
11750 Excision of nail plate and nail matrix, partial or complete (eg ingrown or deformed nail) for permanent removal
17110 Destruction of benign lesions other than skin tags or cutaneious vascular proliferative lesions, up to 14 lesions.
Routine foot care is normally excluded from Medicare coverage except for the following conditions or situations:
Diagnosis and treatment of ulcers, wounds or infections
Trimming or cutting nails to fitted with a cast following fracture.
Metabolic, neurologic, or vascular conditions that may require scrupulous foot care by a professional
Treatment of warts, including plantar warts on the foot
In the absence of systemic condition, treatment of myocotic nails may be covered, only when the following criteria are met:
Clinical evidence of mycosis of toenail and patient has marked limitation of ambulation, pain or secondary infection resulting from thickening and dystrophy of the infected toenail plate.
Clinical evidence of mycosis of the toenail and the patient suffers from pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.
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