11/13/2020

RFC Coding Guidelines-Medicare Advantage Plans

If treating patients with Medicare advantage plans and they are covered for routine foot care every three months does that require class findings and or any other type of diagnosis? And if it’s just to cut the nails what code do we use for routine foot care? Can we use an office visit 99212?

Medicare Advantage plans should follow the same coding guidelines as traditional Medicare. Systemic conditions with a class findings modifier can be reported for the removal of calluses, nail trimming, and nail debridement. If billing with a systemic condition, the DLS and referring provider should also be listed on the claim. If billing under the mycotic nail provision of routine foot care, the service should be covered with a diagnosis of pain, ingrown nails, or cellulitis of the toes.

If billing a nail trimming, it should only be performed if the patient has a systemic condition with CPT code 11719 or HCPCS G0127, depending if the nails are dystrophic or non-dystrophic. It would not be appropriate to bill an E&M code to represent this routine foot care service. The office visit may be billed if the patient was evaluated for another condition or issue not related to routine nail care

Code Description

 11719-Trimming of nondystrophic nails, any number

Lay Description (Code):

A physician trims a fingernail or toenail, usually with scissors, nail cutters, or other instruments. This code is reported when the nails are not defective from nutritional or metabolic abnormalities. It is reported for one or more nails.

Code Description

11720-Debridement of nail(s) by any method(s); 1 to 5

Lay Description (Code):

The physician debrides fingernails or toenails, including tops and exposed undersides, by any method. The cleaning is performed manually with cleaning solutions, abrasive materials, and tools. The nails are shortened and shaped. Report 11720 for one to five nails and 11721 for six or more.

Code Description            

11721-Debridement of nail(s) by any method(s); 6 or more

Lay Description (Code):

The physician debrides fingernails or toenails, including tops and exposed undersides, by any method. The cleaning is performed manually with cleaning solutions, abrasive materials, and tools. The nails are shortened and shaped. Report 11720 for one to five nails and 11721 for six or more.

Code Description            

G0127-Trimming of dystrophic nails, any number

Lay Description (Code):

A physician trims fingernails or toenails usually with scissors, nail cutters, or other instruments when the nails are defective and dystrophic from nutritional or metabolic abnormalities. Report this code for any number of nails trimmed.