Podiatry

Podiatry Billing Guide

Podiatry Local Coverage Determinations

Table of Contents

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LCD for Routine Foot Care and Debridement of Nails (L33636)

Abstract

The Medicare Program generally does not cover routine foot care. However, this determination outlines the specific conditions for which coverage may be present.

The following services are considered to be components of routine foot care, regardless of the provider rendering the service:

  • Cutting or removal of corns and calluses;
  • Clipping, trimming, or debridement of nails, including debridement of mycotic nails;
  • Shaving, paring, cutting or removal of keratoma, tyloma, and heloma;
  • Nondefinitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage;
  • Other hygienic and preventive maintenance care in the realm of self-care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients;
  • Any services performed in the absence of localized illness, injury, or symptoms involving the foot.

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LCD for Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures (L33563)

Abstract

This LCD specifies the indications and limitations for I&D services. I&D is a covered procedure for treating abscesses. I&D and drainage of nonabscess fluid collections is covered when medically necessary due to pain or inflammation. Repeated incision and drainage is not expected, however, in the case of hidradenitis, this may be experienced but the provider must document the reason that more definitive therapy is not appropriate.

Paronychia, when sufficiently treated with avulsion of the nail only, should be billed with CPT code 11730 and not as an incision and drainage. Permanent correction of recurring ingrown toenail by nail resection or wedge excision of the nail lip should be billed with CPT code 11750 or 11765 and not as an I&D.

Podiatrists are limited in scope of practice by state law. Only those ICD-10-CM codes that are appropriate for the scope of practice will be accepted as reimbursable.

The patient's medical record must contain documentation that fully supports the medical necessity for the I&D as well as a full description of the procedure performed.

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LCD for Debridement Services (L33614)

Abstract

Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The codes in this LCD cover debridement of skin, subcutaneous tissue, fascia, muscle, bone and removal of foreign material. Debridement promotes wound healing by reducing sources of infection and other mechanical impediments to healing. Its goal is to cleanse the wound, reduce bacterial contamination and provide an optimal environment for wound healing or possible surgical intervention. The usual end point of debridement is removal of pathological tissue and/or foreign material until healthy tissue is exposed. Debridement techniques include, among others, sharp and blunt dissection, curettement, scrubbing, and forceful irrigation. Surgical instruments may include a scrub brush, irrigation device, electrocautery, laser, sharp curette, forceps, scissors, burr or scalpel. Prior to debridement, determination of the extent of an ulcer/wound may be aided by the use of blunt probes to determine wound/ulcer depth and to disclose abscess and sinus tracts.

This LCD does not apply to debridement of burned surfaces. For debridement of burned surfaces CPT codes 16000-16036 apply. Regulations concerning the use of these codes are not addressed in this LCD. This LCD does not apply to debridement of nails and the provider is referred to NGS LCD Routine Foot Care and Debridement of Nails (L33636).

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LCD for Nonvascular Extremity Ultrasound (L33619)

Abstract

Ultrasound of the extremity is a non-invasive imaging technique that uses high-frequency sound waves to evaluate the extremities (arms and legs), providing real-time, two-dimensional images. Longitudinal, transverse and oblique images of the area of interest are obtained. Ultrasound, echography and sonography are all terms that may be used interchangeably to describe this particular imaging technique. This LCD identifies the indications and limitations of Medicare coverage and reimbursement for these services.

Reviewed 9/13/2024