“Can ‘At Risk,’ Routine Foot Care be billed for a patient that has evidence of neuropathy, no vascular impairment and no Class findings?”
Within Article - Billing and Coding: Routine Foot Care A57957, there is a list of ICD-10-CM codes that represent the diagnoses where the patient has evidence of neuropathy, as demonstrated by methods such as the Semmes-Weinstein monofilament, but no vascular impairment, for which NO Class Findings Modifiers are required.
One of the DPM’s podiatric diagnosis(es) (ICD-10-CM) codes MUST be billed as the primary diagnosis to ensure payment.
Please confirm with your Medicare Administrative Contractor’s LCD for Routine Foot Care.
Covered Indications
- Routine foot care may be available for patients with peripheral neuropathy involving the feet, but without vascular impairment. Therefore, a Q modifier is not required.
- The neuropathy should be of such severity that care by a non- professional person would put the patient at risk.
- The medical record must document the patient has an absence of sensation at two or more sites out of five tested on either foot when tested with the 5.07 Semmes-Weinstein monofilament to support the diagnosis of peripheral neuropathy with loss of protective sensation.
- This test may be performed by the attending physician, non-physician practitioner, or the podiatrist.
“If the patient has neither a neurological nor vascular impairment and no Class findings, can ‘At Risk,’ Routine Foot Care still be covered?”
Within Article – Billing and Coding: Routine Foot Care A57957, there is a list of ICD-10-CM codes/systemic diseases where the patient has neither a neurological nor vascular impairment yet are still covered services.
One of the DPM’s podiatric diagnosis(es) (ICD-10-CM) codes MUST be billed as the primary diagnosis to ensure payment.
Please confirm with your Medicare Administrative Contractor’s LCD for Routine Foot Care.
Covered Indications
- For patients requiring anticoagulation therapy, the provider must document in the medical record the significant risk and danger posed by the non-professional rendering Routine Foot Care services.
- The Q modifier is not required.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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