Podiatry Management Online


Podiatry Management Online
Podiatry Management Online



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Query: Denials for a Richie Brace


Can anyone provide claim guidance for bilateral Richie braces for posterior tibial tendon dysfunction? We are getting denials from United Health Advantage plan. I have submitted the claim with RT and LT. Then resubmitted also using KX modifier. The denials state that the documentation does not support the devices/need.


PM News Subscriber


Response: Unfortunately, there is an insufficient amount of information given to provide you with an exact answer.


Perhaps you have provided the wrong POS 11 (office) not 12 (home); or you forgot to list a referring (prescribing entity - you) on the claim. While these are all possible, it’s also possible that UHC may have elected to require prior authorization, or your contract may exclude you from reimbursement for these services. If you can provide more specific information, perhaps a more specific answer can be provided.


Paul Kesselman, DPM, Woodside, NY


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Other messages in this thread:



Query: Software Billing Options


The current software we are using at our office is going to upgrade and I am not sure I want to continue with the same company. I was looking for suggestions on what other practices are using. I was curious about other options and critiques of those options. 


Brian E. Sicher, DPM, Amarillo, TX


Response: There are many programs out there, all of which meet basic criteria. All of them can get information into some form of an electronic record and can generate a bill. What is important is which one works for you and your staff. Some are more user friendly but might be less sophisticated in terms of what they can do, reports they can generate, etc. Others may be really intense but more than you need. For example, some people use their smartphone to run virtually every aspect of their lives. Others just phone and text.


My computer person told me that some programs are EHR focused and aren’t that good at billing. Others have a robust billing module but the EHR is an add-on product. How computer savvy are you and your staff? A complicated system may just add more stress to your work flow and reduce productivity. My best advice is shop around and find which one works for you. Make sure it is at least 2014 (preferably 2015) certified.


Also consider cost. A younger practitioner may want a program that can expand over time so a more expensive product is a good investment for the future. An older practitioner may want something simpler for the short run. There is no perfect system out there. Take the time to get demonstrations. Include your entire staff in the decision-making.


Tony Poggio, DPM, Alameda, CA


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Query: Same or Similar Product Problems


My biller informed me that we have been getting multiple DME denials from Medicare due to the previous dispensing of same or similar products, some of which were not even provided by our office. This includes L1902 brace denial after CAM boot dispensing for ankle sprains/fracture. The carrier has stated though that only one DME device is covered every 5 years for the same limb if they are similar, including L1902, L4361, L1970, and L1940. Is this truly the case, even if the diagnosis is different?


PM News Subscriber


Response: This question continues to create issues for many orthotic and prosthetic providers and is not limited to podiatrists. I’ll try to explain this complex subject without cutting and pasting complex language from CMS or the carriers:


Medicare has a five year “look back” on all base products within the AFO because the policy considers that a patient cannot wear more than one AFO on one limb at a time. This, of course, is an absurd policy which many provider organizations are working together to resolve with...


Editor's note: Dr. Kesselman's extended-length response can be read here.


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Query: Billing for a House Call


How do I bill for a house call? Any thoughts on where I can get educated on this?


Dan Altchuler, DPM, Santa Monica, CA


Response: To begin with, the code series to bill is CPT 99341-99350. After that, the rules are basically the same as in the office where you bill the level of service based upon history, exam, and decision-making. If you do a procedure(s) at the same time as the home visit, then the same modifier combinations apply as they would in the office. Time can be used to determine the E/M level but that is only face-to-face time and does not include travel time or associated expenses.


Medicare used to have a rule that the patient needed to be housebound in order to be reimbursed for home services. That has changed so there are no restrictions beyond the fact that services need to be medically necessary and reasonable. Routine foot care is covered as long as they meet the at-risk or pain criteria, just like in the office.


The big caveat is that you are not entitled to bill for a house call E/M just because you went to the house. Unlike your plumber who bills a service fee to come out and then bills on top of that for what they do once they get there, we can not. Just like in the office, if you are rendering a service were the E/M is not significant and separately identifiable, you can only bill the procedure. If the service is non-covered, then you can bill your usual and customary fee. If it is covered, you are bound to the fee schedule. So if you are doing a house call and all you are doing is trimming nails, CPT 11719, that is all you are entitled to.


Tony Poggio, DPM, Alameda, CA


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Query: Talar Dome Fracture with Malleolar Osteotomy


I recently did an open reduction and interfixation of a talar dome fracture with a medial malleolar “take-down” osteotomy. I was thinking I would bill a CPT 28445 with CPT 27705. Would this be appropriate?


Aamir Mahmood, DPM, Oakbrook, IL


Response: There are times when life can be unfair and in some cases, surgical coding follows this path. When an osteotomy is performed to expose and repair a fracture, as in this case, the insurers consider the osteotomy to be a component of the open reduction and fixation of the talar dome fracture. Therefore, I would expect that payment will be limited to:


CPT 28445 open treatment of talus fracture, with or without internal fixation.


Howard Zlotoff, DPM, Camp Hill, PA


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Query: Metatarsal Resection


Which is the code that best describes the following procedure involving the 5th metatarsal for a diabetic foot ulcer with suspected osteomyelitis? The head and neck of the 5th metatarsal showed abnormalities with more discoloration, cortical disruption, and softening. A sagittal saw was used to resect the head of the 5th metatarsal and adjoining base of the proximal phalanx base and these were removed and passed from the operative field and are to be sent for pathology. A portion of the 5th metatarsal bone was obtained for a C&S.


Colette Weber, DPM, St. Louis, MO


Response: I recommend the following codes for the procedure you have described:


CPT 28113 resection, fifth metatarsal head


CPT 28126 resection, partial or complete, phalangeal base, each toe


Howard Zlotoff, DPM, Camp Hill, PA


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Query: New Rules for Dispensing of Diabetic Shoes in New Jersey


Is it true that in New Jersey, the dispensing of diabetic shoes and inserts has changed from once yearly to once every 5 years for Medicare patients starting in March 2020? If true, does this rule apply to all DME dispensed in the office to Medicare patients?


PM News Subscriber


Response: For Medicare and Medicare Advantage Plans, it’s easy to separate fact from fiction:


Fiction: Therapeutic shoes are DME and the policy is listed with AFOs and governed by the AFO LCD.

Fact: Therapeutic shoes are NOT DME but they are paid by the DME contractors. They have a separate policy that is listed within the DME LCD.


Fiction: You can dispense all DME via telehealth.

Fact: Therapeutic shoes and AFOs may not be dispensed via telehealth. Certain DME supplies may be shipped to the patient. Primary example for podiatric physicians is surgical dressings.


Fiction: Once a patient receives an AFO, they cannot receive another for five years.

Fact: While somewhat difficult to appeal, there is significant latitude within the AFO LCD to allow for replacement if the item is lost or stolen, no longer fits, or change is required due to a change in diagnosis.


As for NJ Medicaid and non-Medicare associated policies, I suggest you obtain those policies as Medicare guidelines may or may not apply. The above are factual. Please check the DME MAC websites for more information.


Paul Kesselman, DPM, Woodside, NY


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Query: Trouble with AllCare


I am having an issue with AllCare Independent Physician Association in which I am a contracted provider (Medicare Advantage Plan). I am located in Northern CA. They are denying claims stating that they “are not medically necessary.” The initial visit was billed as an E/M 99202. Two following visits dated more than two months apart were denied for the same reason. The codes used on the 2nd and 3rd visits were CPT 11057 and CPT 11721. We have appealed these claims to AllCare on more than one occasion with all necessary documents. A recent telephone call to them to check on status is when we were informed that none of these were “medically necessary.” Do I have any recourse elsewhere?


Howard Miller, DPM, Manteca, CA


Response: MAPs must follow the same guidelines as Medicare does for the coverage of these services, although they can pay differently. My initial observation without seeing the actual claim is perhaps they are missing the necessary at risk diagnoses needed to make these “medically necessary”? I wonder if they needed a diagnosis of diabetes, peripheral arterial disease, or similar to actually qualify for the use of the CPT 11057 and CPT 11721? Perhaps “pain” for the CPT 11721.


I would ask them for their policy on coding for these services and what is necessary and re-submit with the appropriate coding and documentation.


Michael King, DPM, Nashville, TN


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Query: Talar OATS Procedure with Fibular Osteotomy


Our podiatrist performed a talar OATS procedure and had to perform a fibular osteotomy to get access to the site (this was not the graft). He had to repair the fibula with plates and screws. Can we bill for the repair? The CPT used for the OATS procedure is CPT 28446. I need help with the fibular osteotomy repair.


Della Roes, Biller, Lake Havasu city, AZ


Response: 1) The osteotomy/repair to gain access for the procedure is not payable as a separate procedure.


2) Make sure you pre-authorize the surgery. Some carriers only allow this type of procedure in the knee and deem it investigational elsewhere.


Tony Poggio, DPM, Alameda, CA


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From: Arnold Ross, DPM


Is the second toe long or is the metatarsal parabola the anatomical cause? If the 2nd metatarsal is long (or there is a short 1st met), as opposed to the 2nd toe being long, you may need to shorten the metatarsal, which I believe is the CPT 28308 code.


Arnold Ross, DPM, Los Angeles, CA



Query: Is Same and Similar Like This Across All Jurisdictions?


I am curious to see if Medicare DME claims are being treated the same across other jurisdictions. I have seen few payments for any “off the shelf” boots, braces, or even custom items. I see near immediate denials only to be informed that a “same and similar” device was dispensed in the past 5 years. Appeals and re-determinations seem to fall on deaf ears and the time it takes to appeal these claims is becoming more cumbersome, even with their online submission process. It is nearly impossible to use a temporary fitting walking boot or simple brace while waiting for a more permanent option (i.e. custom brace or other device) without receiving a denial.


PM News Subscriber


Response: This scenario is exactly why APMA, AOPA, PFA, AOTA, APTA and others including AAOAS AOFAS have been petitioning CMS to get this 5 year rule changed. Every supplier should be enrolled into all four DME portals, and a same/similar (S/S) check should be run prior to dispensing anything. Again, the search for S/S should be run in at least one DME MAC in JA or JD and again in JB or JC. If these are clean or hit something, you must print them and save them. Then prepare your dispensing note to say why the previous dispensed device is inadequate (e.g. Cam walker dispensed two years ago for left ankle sprain is inappropriate for a patient requiring a custom AFO with greater deformity for PTTD and the custom device is required because the patient needs to be treated in all three planes and has a new diagnosis of…). Then, the previous device is inappropriate and places a clear and present danger to the patient. You can then appeal your initial claim rejection as a re-determination through the same portal. 


It’s interesting that MCR chooses not to share S/S info via the provider portal, but does so in their claims processing. Unfortunately, the rules are not fair and are slanted in favor of the carrier (what else is new). If you wish to proceed with a new device during a global period (5 years is absurd), be sure you properly complete an ABN. These are very tricky and must be detailed. I urge you to Google “How to Properly prepare an ABN.” Not only should you review those provided by CMS, but those of others in the DME industry.


Paul Kesselman, DPM, Woodside, NY


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Query: Morton Toe Correction


I have a patient with a painfully long second toe. This digit is not contracted. She would like the toe shortened to relieve her pain and to better match the rest of her toes. Would I simply use the hammertoe correction code (CPT 28285) or is there a more appropriate code to use?


David Williams, DPM, El Paso, TX


Response: 1) a toe deformity that is not a hammertoe that developed over time is properly coded for ICD-10-CM as:

a) M20.5X1 Other deformities of toe(s) (acquired), right foot

b) M20.5X2 Other deformities of toe(s) (acquired), left foot


2) When you remove a phalanx of bone this is not a hammertoe correction. Instead, it is anatomically specific depending on what you are removing. These are your 5 options:

a) CPT 28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe

b) CPT 28126 Resection, partial or complete, phalangeal base, each toe

c) CPT 28150 Phalangectomy, toe, each toe

d) CPT 28153 Resection, condyle(s), distal end of phalanx, each toe

e) CPT 28160 Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each


David J. Freedman, DPM, CPC, Silver Spring, MD


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Query: Coding Injections


What is the best CPT code to use to bill Medicare for injecting steroid for tarsal tunnel or Baxter’s neuritis? In the past, I have used CPT 64450, but always got denied.


Hratch Demirjian, DPM, Covina, CA


Response: Ironically, as of January 1, 2020, the best CPT code to use to bill Medicare for injecting steroid for tarsal tunnel or Baxter’s neuritis is CPT code 64450. Why? Well, things have changed. CPT code 64450 is now defined as: Injection, anesthetic agent(s) and/or steroid; other peripheral nerve or branch.


CPT codes 64400-64489 describe the introduction/injection of an anesthetic agent and/or steroid into the somatic nervous system for diagnostic or therapeutic purposes.


CPT codes 64400-64450, 64XX0X describe the injection of an anesthetic agent(s) and/or steroid into a nerve plexus, nerve, or branch. These codes are reported once per nerve plexus, nerve, or branch as described in the descriptor, regardless of the number of injections performed along the nerve plexus, nerve, or branch described by the code.


Therefore, if steroid is being injected into the tarsal tunnel or for Baxter’s neuritis of a Medicare patient, the appropriate CPT code would be 64450, appended by the correct anatomical modifier, either RT or LT as appropriate. If the injection is for tarsal tunnel syndrome, for example, the appropriate ICD-10-CM code to link to the CPT code would be G57.51 (Tarsal tunnel syndrome, right lower extremity) or G57.62 (Tarsal tunnel syndrome, left lower extremity).


Michael G. Warshaw, DPM, CPC, Lady Lake, FL


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RE: Modifier -59 Versus XS


We are having issues billing CPT 11055 with CPT 11720 -59 modifier. Insurance companies Anthem Blue, MCR, and Optium UHC are denying CPT 11720 with -59 for the lesions as it is “not an appropriate modifier.” I was doing some more reading under global surgery modifiers. Should we be using the XS separate and distinct modifier instead? It is notated in the office: note the location and digit for the lesion removal, toe code, and if we are to using it for the lesions. Should we consider this modifier for all insurances in these scenarios?


Robert Rutstein, DPM, Hartford, CT


Response: CMS started the “X” modifiers on or after January 1, 2015 and payer by payer seems to allow their use. To your blanket question: “Should we consider this modifier for all insurances in these scenarios?”: my answer is "no". My qualifying statement is to check with the payer policy to see if they accept the X modifiers. Next, about billing CPTs 11720 and 11055. If they do not accept -59, then I suggest XS for UHC. Make sure the diagnosis matches their policy for coverage. I usually bill as an example the systemic diagnosis for coverage, i.e. E11.51/E11.42 or I73.9 and L84 as secondary to UHC for the CPT 11055. For CPT 11720, I usually bill the systemic diagnosis for coverage, i.e. E11.51/E11.42 or I73.9 and B35.1 as secondary to UHC.


David J Freedman, DPM, CPC, Silver Spring, MD


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Query: Ciox Medical Records Release Request


We have been getting a lot of medical records releases from Ciox. They are requesting 50 charts, 45 charts, etc. Is there any time limit we must follow to release medical records to them? Also can we charge them? 


Kiss Woo, Dr. Wendy Wu’s office, Monterey Park, CA


Response: My opinions (not based on law but just based on my instincts) are: You have a contractual obligation to provide charts when they are necessary to process claims and/or for any post-payment investigations of payment regarding that claim (pre-authorizations, etc). In my opinion, that does not include data mining for the insurance carrier, where the carrier is not investigating your claim and chart notes to obtain a refund from you. But the purpose of this data mining is simply an attempt by the carrier to be paid more based on risk categories. That is, the more differential diagnosis listed in the patient’s diagnosis for ALL their doctors, the higher their risk and the more CMS pays the Medicare Advantage carrier. You have no obligation to provide those charts at NO charge. My office lets CIOX understand this from the beginning. When I was in full time practice, I asked for $50 a chart and usually settled on $25. They often would promise me payment after the charts were sent. Since I have no leverage over CIOX, if I deliver the goods and they don’t pay me, I would not agree to that. On the other hand, CIOX has a huge amount of leverage if I didn’t provide the charts after I was paid. I don’t deliver. Thus, payment was either expected in advance or never provided.


Often, I would continue to obtain letters, faxes from CIOX, all of which were responded to in the same manner. Sometimes I was paid; often I was not. When I was paid, I provided the materials requested. If I wasn’t paid, I did not send them anything. This is an ongoing saga. Again, these are not legal opinions as those can only be provided after your attorney reviews your contract. The fact that CIOX often agrees to the terms I’ve outlined above, must indicate that it’s legal.


Paul Kesselman, DPM, Woodside, NY


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From: Kristin Happel


When faced with denials for medical necessity like Dr. Block has with CPT 29540, the first thing to do is see if the insurance company denying the charge has an LCD/NCD in place for the code being denied. These coverage determinations will clearly state which diagnoses are considered medically necessary. In this case, the insurance is Medicare, and the state is Florida, so FCSO is the MAC. Unfortunately, they do not have an LCD for CPT 29540, and there is no NCD for 29540 either. Novitas Solutions, which is another MAC, DOES have an LCD for CPT 29540, which lists covered diagnoses. This would be at least a guide to what diagnoses are potentially covered by FCSO, although there may be some variance, but it is at least a place to start - Neither diagnosis.


Dr. Block states [the code] she has used is covered by that LCD. The pain in foot diagnosis of M79.671/M79.672 is simply not specific enough, and I can't see any insurance company covering a CPT 29540 for that diagnosis alone. While the M76.821 is more specific, it could be that...


Editor's Note: Ms. Happel's extended-length letter can be read here.



Query: Naming Neuropathy


A primary care physician referred a patient to me for toenail care. The referral listed the diagnosis as “neuropathy.” There was no ICD-10 code listed. My state’s LCD lists some forms as neuropathy that qualify for nail care, but not all forms of neuropathy are listed. If I assign a diagnosis of G63 (polyneuropathy in diseases classified elsewhere), which qualifies per my state’s LCD, would this survive a Medicare audit for the patient’s toenail care?


Troy Harris, DPM, Jacksonville, FL


Response: “Idiopathic neuropathy” represented by ICD-10 code G63.0 is a valid diagnosis and is considered and listed as a “Category 4” qualifying diagnosis in most “Routine Foot Care” MAC LCDs. No “Q” modifiers are needed in this case.


Joseph Borreggine, DPM, Port Charlotte, FL


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Query: Struggling with Strapping


I’ve been getting a lot of C050 denial codes from Medicare when billing CPT 29540. I’ve billed an E/M code the same day for a different problem with a -25 modifier. It appears to be the appropriate code to use and it is documented in my medical records. I’ve had denials when using it with diagnosis M79.671 as well as M76.821 diagnosis on different patients. Is anyone else having this problem and is there a modifier that needs to be added?


Caren Block, DPM, West Palm Beach, FL


Response: The use of the -25 modifier has been a hot area of focus for the insurance industry. To be fair, some providers think every time the patient enters their office there should be an automatic E/M charge allowed no matter what services are performed. This is not the case. The proper use of the -25 modifier has been discussed many times in the past on Codingline. Some carriers have done spot audits using billing practices to deny certain claims (such as denying a procedure with E/M -25 if billed X times in a row). Others have simply denied all E/M services with a -25 modifier, expecting the provider to appeal (with chart notes), defending their billing. Unfortunately, with the current time constraints caused by lower reimbursements, the need to see more patients, charting requirements, MIPS, etc. (not Covid-related), our charting may be less than perfect.


I personally think the insurance carriers are banking on that. The E/M -25 service may be, in fact, legitimate; but with only a few sentences in the chart note, the chart won’t pass muster. That is the problem. There is no magic modifier. Your only strategy is to make sure that you review your chart note and make sure there is enough documentation to justify the use of the -25 modifier. If in your review, the service is legitimate but the charting is poor, then you need to fill in the blanks better. If on the other hand, you have charted all you could but there isn’t enough, then maybe the -25 modifier is not warranted. This self-audit is an educational opportunity either way.


Tony Poggio, DPM, Alameda, CA


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Query: Coding For Dry Needling


I have a patient that has chronic Achilles tendonitis. We have failed multiple conservative treatment options and we now planning dry needling at her next appointment. Are there options for coding this procedure?


Archived Codingline Question


Response: Procedure codes for dry needling include:

CPT® 20560 – Needle insertion(s) without injection(s); 1 or 2 muscle(s)

CPT® 20561 – Needle insertion(s) without injection(s); 3 or more muscles


Jeffrey D Lehrman, DPM, CPC, Fort Collins, CO


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Query: Medicare and Work Comp Confusion


I received a denial from NGS Medicare (Bethpage, NY) for CPT 99213 with denial code 19, “this is a work-related injury/illness and thus the liability of the Workers Compensation Carrier”. The CPT 99213 was billed for an unrelated condition. How can this be addressed?


David Sands, DPM, Great Neck, NY


Response: Unfortunately, the error you are receiving cannot simply be appealed or be avoided with a modifier. The error stems from an active case in the patient's common work file (CWF). NYS Workers' Comp has an open case on a work-related injury and thus Medicare will not cover this unless the CWF is cleared. This can only be accomplished by having the patient contact both the NYS Workers' Comp Board and Social Security. Once your patient has confirmed this, you can resubmit the claim.


One caveat to all this is that with a patient eligibility check through a myriad of software vendors, your front office staff would know this prior to seeing the patient.


Paul Kesselman, DPM, Woodside, NY


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Query: Intramuscular Injection Code


On rare occasion, I will do an intramuscular injection. It has been a few years now, actually, so I tried the CPT 96732 along with the J code. My EMR will not accept that code and I couldn’t find information in the Codingline archives. I assume it has been deleted. Is there another appropriate CPT code to use for an intramuscular injection?


David E Gurvis, DPM, Avon, IN


Response: There is no 96732 CPT code. If you are performing a trigger point injection into a muscle, consider: CPT 20552 Injection(s); single or multiple trigger point(s), one or two muscle(s).


Jeffrey D Lehrman, DPM, CPC, Fort Collins, CO



From: Dennis Shavelson DPM


I agree with Dr. Lehrman to use ICD-10 U07.1 for COVID-19 if diagnosed but I suggest using Code Z20.828: Contact with and (suspected) exposure to other viral communicable diseases which is a billable code. That would be underpinning the Covid toes findings such as chilblains, Raynauds, or acrocyanosis (I73.8).


Dennis Shavelson, DPM, NY, NY



Query: COVID toes


Any suggestions for an ICD-10 code for COVID toes?


Lori Weisenfeld, DPM, NY, NY


Response: I do not think any doctor should be using the term “COVID toes.” That would sort of be like a podiatrist calling the 5th toe the “little piggie.” There have been some reports in peer-reviewed literature of COVID-19 diagnosed patients having Chilblains-Like Lesions (CLL). Right now, the true prevalence and pattern of any COVID-19 dermatologic manifestations are still unknown.


If you see a patient with skin changes in their toes, I suggest you consider these diagnoses and pick the one that is most appropriate:

R23.0 Cyanosis

R23.1 Pallor

R23.2 Flushing

R23.3 Spontaneous ecchymoses

R23.4 Changes in skin texture

R23.8 Other skin changes


If you see a patient with diagnosed COVID-19, and that somehow plays a role in your management of that patient, the diagnosis code for COVID-19 is U07.1


Jeffrey D Lehrman, DPM, CPC, Fort Collins, CO


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From: Sam Mendicino, DPM


We are in a medical specialty where this is rare. I personally would not charge the patient or insurance company. I would call the patient periodically and ask, “How are you doing?” Sometimes, we focus on what’s least important. If it were your parent, how would you feel? The patient already appreciates what you did. Don’t give the patient anything else to worry about.


Sam Mendicino, DPM, Houston, TX



Query: In-Office Emergency


We had a patient come in for routine debridement of her diabetic ulcer. While she was in the exam chair she became unresponsive. We assessed her and found her pupils were constricted, her blood pressure was 160/100 and she was clammy and diaphoretic. 911 was called and we administered oxygen and monitored her until they arrived. What would you suggest I bill along with the debridement of the ulcer?


Ahmed Buksh, DPM, Edmond, OK


Response: Basically, my answer is that you bill for what you did and documented; no more, no less. If you feel the visit was truly completed and your triage was key in maintenance of the patient, I would surely do an E&M consistent with what you did and noted. Having an emergent situation may add some level of intensity, but the billing for that would be consistent with what you actually did and was within your scope of practice in Oklahoma. If you were able to debride the ulcer, nothing changes in how you bill that. You should bill the debridement based on the typical and accepted standards of depth, size, etc.


Michael King, DPM, Nashville, TN


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Query: Does a Telehealth Visit Count as Date Last Seen?


Will a telehealth visit with the physician who is managing a patient’s diabetes count as a date last seen for qualified routine foot care?


Mary Gail Kwiecinski, DPM, Libertyville, IL 


Response: When the LCD for “Routine Foot Care” of a Medicare Administrative Carrier is accessed, any approved systemic diseases that are designated with an asterisk (*) mandate that a patient with any one of these diseases, who sees a podiatrist for “At Risk, Routine Foot Care, must have seen his/her PCP that is treating the patient for that systemic disease within the prior 6-month period at least one time specifically for that systemic disease. This is referred to as the “Active Care Requirement.”


With respect to a telehealth visit, why wouldn’t the same criteria apply? If the patient has diabetes mellitus and has a telehealth visit with the PCP who is treating the patient for the diabetes mellitus and during the telehealth visit reviews the lab work that was obtained prior to this virtual encounter, discusses the patient’s medication, etc., this is essentially what would be performed during an actual face-to-face visit. If this was indeed performed within the 6 month period prior to the “At Risk,” Routine Foot Care encounter, then the patient would meet the standard as illustrated within the LCD and the NCD, as well. Just to cover my butt, I would ask the PCP to forward to me a copy of the encounter that took place during that specific telehealth visit.


Michael G. Warshaw, DPM, CPC, Lady Lake, FL


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