KUDOS!

 We received a nice thank-you note from a member who had some challenges with CPT® codes 11720 and 11721. Their office is now able to obtain appropriate financial reimbursement without frustration.

We want to share what we were able to pass on to our members thanks to the guidance of Jeffrey D. Lehrman, DPM, Certified Professional Coder, and Certified Professional Medical Auditor.

For Medicare Part B beneficiaries in Pennsylvania, Novitas has two different policies that govern covered foot care (below). 

• These are separate policies with no overlap between the two. 
• Each time a patient is seen for covered foot care, it is essential to determine and document which policy the patient is covered under without confounding the two. 

The two policies are: 

1.  Routine Foot Care:https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35138&ver=39&name=336*1&UpdatePeriod=828&bc=AAAAEAAAAAAA&

2.  Debridement of Mycotic Nails:https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35013&ver=31&name=331*1&UpdatePeriod=841&bc=AQAAEAAAAAAA&

The Routine Foot Care policy generally covers patients who have both:

1. One of the qualifying systemic diagnoses in the policy

AND 

2. Class findings

This policy makes no mention of onychomycosis or pain, or limited ambulation.

The Debridement of Mycotic Nails policy covers patients who have both: 

1. Onychomycosis

AND

2. One of three secondary diagnoses listed in the policy

This policy makes no mention of a systemic diagnosis or class findings.