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MP 9.01.01 (Archived) Foot Care Services

Medical Policy
Section
Miscellaneous Policies
 
Original Policy Date
7/31/97
Last Review Status/Date
Archived/2:2011
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Foot care services include the examination, diagnosis, and medical or surgical treatment of conditions and dysfunctions of the foot.


Policy

Foot care services are considered medically necessary when all of the following criteria are met:

  • the services are delivered by a qualified provider of foot care services. A qualified provider is one who is licensed and is performing within the scope of licensure; and
  • the services are considered by the Plan to be specific, effective, and reasonable treatment for the patient’s diagnosis and condition.

Routine foot care, i.e., hygiene and preventive maintenance such as trimming of corns, calluses, or nails, does not usually require the skills of a qualified provider of foot care services, and, as such is considered not medically necessary. However, for patients with comorbidities such, as diabetes or peripheral vascular disease, which can impede healing and can jeopardize life or limb, routine foot care is considered medically necessary.

Manual debridement and electric grinding procedures of the toenails, when performed by qualified providers, are considered medically necessary only for the following conditions:

  • onychomycosis (mycotic nails), when confirmed by positive culture or by documented signs and symptoms, which substantiate difficulty in wearing shoes or in ambulation;
  • onychauxis (club nail), onychodystrophy (deformed nail), and onychogryposis (thickened nail), when such conditions result in paronychia or pain from gross distortions of the nail, as well as difficulty in wearing shoes or in ambulation.

Pre-operative, non-invasive vascular studies (Doppler or segmental plethysmography or duplex scan) are considered medically necessary with the following diagnoses, symptoms, or signs:

  • Symptomatic peripheral arterial disease, e.g., arteriosclerosis obliterans, Buerger’s disease; diabetes mellitus;
  • Non-traumatic amputation of the foot or any part thereof;
  • Ischemic ulcer;
  • Intermittent claudication or other ischemic-type pain; OR
  • At least three (3) of the following:
    1. non-palpable pedal pulses;
    2. decreased hair growth in the leg;
    3. nail overgrowth;
    4. abnormal skin texture (thinning);
    5. abnormal skin color/temperature (i.e., cold feet);
    6. pigmentation changes.

Nerve blocks performed for the purpose of increasing blood supply to the foot and toes are considered not medically necessary.


Policy Guidelines

At a minimum, an injectable local anesthetic must be used in order for a foot care procedure to be considered “toenail surgery.”

Preoperative x-rays are medically necessary when performing:

  • invasive procedures, including closed or open reduction internal fixations, on bones or soft tissue of the foot; or
  • closed reduction of fracture(s), fracture/dislocation, or dislocation of the foot;
  • ruling out of foreign body in the foot.

Bilateral x-rays of the feet are medically necessary for:

  • bilateral conditions/diagnoses that require bilateral procedures;
  • pediatric foot conditions prior to closure of growth plates; foot conditions/or
  • congenital conditions such as tarsal coalition, accessory navicular, and bipartite sesamoids.

Postoperative x-rays of the foot are medically necessary when performing:

  • invasive procedures of bones, joints, and/or soft tissue releases that can alter anatomical alignment of the foot, such as surgery for club feet;
  • hardware insertion during closed or open procedures;
  • after closed and/or open reduction of fractures, fracture/dislocation, and dislocation;
  • only the operative side requires postoperative x-rays, even if bilateral pre-operative x-rays were performed; or
  • if a radiopaque foreign body has been located and removed.

Contraindications to steroid injections are the development of avascular necrosis, infection, delayed or non-union of fractures, Charcot joints, and neuropathy.

With the exception of osteotomies or delayed or non-union of bones, benefits for postoperative films should be limited to one and only when covered bone surgery has been performed.

Radiology services other than those listed in the guidelines are not considered medically necessary without supporting documentation.


Benefit Application

BlueCard/National Account Issues

Services that are generally considered to be routine foot care services are considered to be medically necessary if incidental to a medically necessary, skilled procedure (e.g., toenail trimming prior to application of a restrictive cast). In most cases, such services are considered to be part of the global surgical fee, and no additional benefits are provided, unless performed of necessity by a different provider.

When partial or total removal of a toenail by surgical means is performed for distorted nails or infections such as onychomycosis, onychauxis, onychogryposis or onychocryptosis (ingrown toenail), removal of medial and lateral (tibial and fibular) borders is considered to be an integral part of the procedure, and no additional benefits are provided.

Benefits are provided for only the primary procedure when a procedure is composed of several components that are considered to be part of the primary procedure, e.g., bunionectomy with sesamoidectomy, tendon surgery, and surgery for hammertoe.

Doppler studies or segmental arterial pressure measurements using a stethoscope or hand-held Doppler ultrasound are considered to be part of the office visit, and no additional benefits should be provided.

All non-invasive vascular studies imply bilateral examination; bilateral comparison studies are therefore provided as a single unit. Benefits are provided at a lesser fee for unilateral examination.

Laboratory procedures relating to foot care must be medically necessary for the condition that is being treated and must be performed by a qualified provider of laboratory services.

Nerve blocks, including somatic nerve blocks, performed for local anesthesia purposes are considered an integral part of the procedure, and no additional benefits are provided.

Medication used with arthrocentesis is included in the basic allowance for the procedure, and no additional benefits are provided.


Rationale

The research for this policy was complied using a combination of standard billing practices, local Plan policies, and claims experience.

 

Codes

Number

Description

CPT  20550  Injection(s); tendon sheath, ligament 
  20551  Injection(s); tendon origin/insertion 
  20600, 20605, 20610  Arthrocentesis code range 
  28300, 28302, 28304, 28305, 28306, 28307, 28308, 28309, 28310, 28312  Osteotomy code range 
  28800, 28805, 28810, 28820, 28825  Amputation, foot code range 
  93925 – 93926  Duplex scan of lower extremity arteries, or arterial bypass grafts code range 
  93970 – 93971  Duplex scan of extremity veins including responses to compression and other maneuvers code range 
  99201 – 99205  Office visit, new patient code range 
  99211 – 99215  Office visit, established patient code range 
  99241 – 99245  Office or other outpatient consultations, new or established patient code range 
  99271 – 99275  Confirmatory consultations, new or established patient code range 
ICD-9 Procedure  77.28  Wedge osteotomy, tarsals and metatarsals 
  77.38 – 77.39  Other division of bone, tarsals and metatarsals, phalanges code range 
  81.91  Arthrocentesis 
  81.92  Injection of therapeutic substance into joint or ligament 
  83.49  Other excision of soft tissue 
  83.96  Injection of therapeutic substance into bursa 
  83.97  Injection of therapeutic substance into tendon 
  84.11  Amputation of toe 
  84.12  Amputation through foot 
  84.13  Disarticulation of ankle 
  88.77  Diagnostic ultrasound of peripheral vascular system 
  89.58  Plethysmogram 
ICD-9 Diagnosis  110.1  Onychomycosis 
  250.00 – 250.93  Diabetes mellitus code range 
  250.70 – 250.73  Diabetes with peripheral circulatory disorders (must be used with another code to specify the circulatory disorder) 
  270.0 – 277.9  Metabolic disease code range 
  320.0 – 359.9  Neurologic disease code range 
  414.00 – 414.05  Coronary atherosclerosis code range 
  429.2  Cardiovascular disease, unspecified (includes arteriosclerotic disease) 
  433.9  Intermittent claudication 
  440.2  Arteriosclerosis obliterans 
  440.9  Generalized and unspecified atherosclerosis (includes arteriosclerosis obliterans) 
  443.1  Thromboangiitis obliterans (Buerger’s disease) 
  443.81  Peripheral angiopathy in diseases classified elsewhere. (Code cannot be used alone. Should follow code for underlying disease, e.g., diabetes mellitus). 
  443.89  Other specified peripheral vascular diseases 
  443.9  Peripheral vascular disease, unspecified 
  457.1  Lymphedema secondary to specific disease, e.g., Milroy’s disease Malignancy 
  459.81  Chronic venous insufficiency 
  681.11  Onychia and paronychia of toe 
  682.9  Chronic indurated cellulitis 
  703.8  Other specified diseases of nail (includes onychauxis, onychogryphosis, onogryphosis) 
  707.1  Ulcer of lower limbs, except decubitus (includes ischemic ulcer) 
  707.9  Chronic ulcer of unspecified site 
  729.5  Foot pain 
  733.81 – 733.82  See specific code for diagnosis reported 
  757.0  Malunion and nonunion of fracture 
  782.3  Intractable edema – secondary to specific disease e.g., congestive heart failure (CHF), kidney disease, hyperthyroidism 
  V49.70  Status post lower limb amputation, unspecified level 
  V49.72  Status post lower limb amputation, toes (code range) 
  V49.73  Status post lower limb amputation, foot 
HCPCS  S0390  Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit 
Type of Service  Surgery 
Place of Service  Inpatient
 
Outpatient
 
Physician’s Office
 


Index

Chiropody
Foot care services
Orthopedic surgery
Orthotics
Podiatric medicine


Policy History

Date Action Reason
07/31/97 Add to Surgery section New policy
04/15/02 Replace policy Policy reviewed without literature review; new review date only
10/09/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled.
2/2011 policy archived  


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