Routine Foot Care (S0390)
Routine foot care is generally not covered. A participating, preferred, or network provider can bill the member for these services when they are denied. However, certain groups do provide coverage for routine foot care. Specific coverage information for each group is identified in the benefits schedule.
When a benefit, routine foot care is covered according to the guidelines identified in this policy.
Professional treatment of corns, callouses, clavus, tyloma or tylomata, plantar keratosis, hyperkeratosis and keratotic lesions, bunions (except capsular or bone surgery thereof), and nails (except surgery for ingrown nails and/or debridement of symptomatic, hypertrophic nails) is reimbursable only if the patient is being treated for one of the following diagnoses:
Amyotrophic Lateral Sclerosis (ALS) (335.20)
Arteriosclerosis obliterans (A.S.O., arteriosclerosis of the extremities, occlusive peripheral arteriosclerosis) (440.20-440.24, 440.29, 440.9)
Arteritis of the feet (447.6)
Buerger's disease(443.1)
Chronic indurated cellulitis (681.10-681.11, 682.6, 682.7, 682.9)
Chronic venus insufficiency (459.2, 459.30-459.33, 459.39, 459.81, 459.9)
Diabetes mellitus (250.00-250.93, 357.2, 648.00-648.04)
Intractable edema - secondary to a specific disease (e.g., congestive heart failure (CHF), kidney disease, hypothyroidism) (459.10-459.13, 459.19, 782.3)
Lymphedema - secondary to a specific disease (e.g., Milroy's disease, malignancy) (457.1, 757.0, 782.3)
Peripheral neuropathies involving the feet (337.1, 356.0-356.4, 356.8, 356.9, 357.0-357.7, 357.81, 357.82, 357.89, 357.9)
Some causes of peripheral neuropathy include:
- Malnutrition and vitamin deficiency malnutrition (357.4, 579.9):
Alcoholism malabsorption (357.5)
Celiac Disease (579.0)
Pellagra (265.2)
Pernicious anemia (281.0)
Tropical Sprue (579.1)
- Carcinoma (357.3)
- Diabetes Mellitus (250.00-250.93, 357.2, 648.00-648.04)
- Drugs and toxins (357.6, 357.7)
- Hereditary disorders:
hereditary sensory radicular neuropathy (356.2)
angiokeratoma corporis diffusum (Fabry's)(272.7)
amyloid neuropathy (277.3)
- Leprosy (030.0-030.3, 030.8, 030.9)
- Multiple Sclerosis (340)
- Neurosyphilis (094.0-094.3, 094.81-094.87
- Traumatic injury (959.7)
- Uremia (585.1-585.9)
Peripheral vascular disease (440.9, 443.81-443.89, 443.9)
Post-phlebitic syndrome (459.10-459.13, 459.19)
Raynaud's disease (443.0)
Stricture of artery (447.1)
Whirlpool treatment, procedure code 97022, performed before routine foot care to soften the nails or skin is not eligible for separate reimbursement.
Debridement of Mycotic Nails (S0390)
Debridement of mycotic nails is considered routine foot care (S0390). It is not a covered service unless otherwise identified in the benefits schedule. However, debridement of symptomatic non-mycotic hypertrophic nails is considered a covered service.
Debridement of Non-mycotic Hypertrophic Nails (11720, 11721)
Debridement of symptomatic (non-mycotic) hypertrophic nails should be processed for payment under the following codes:
11720 - Debridement of nail(s) by any method(s); one to five
11721 - six or more
Payment for debridement of hypertrophic nails is limited to once per patient every 60 days. More frequent debridements are not medically necessary.
Fungal (mycotic) infections of the feet and toenails may require professional medical care outside the scope of routine foot care. Medical treatment of a fungal infection of the feet should be reported with the appropriate visit code.
Whirlpool treatment, procedure code 97022, performed prior to debridement of mycotic/hypertrophic nails to soften the nails or skin is not eligible for separate reimbursement.
Coverage for routine foot care is determined according to individual or group customer benefits.
Description
Routine Foot Care (S0390)
Routine foot care includes the treatment of corns, callouses, clavus, tyloma or tylomata, plantar keratosis, hyperkeratosis and keratotic lesions, bunions (except capsular or bone surgery thereof), and nails (except surgery for ingrown nails and/or debridement of symptomatic, hypertrophic nails). Treatment of these conditions may pose a hazard when performed by a non-professional person on patients with a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the legs or feet.
Debridement of Mycotic Nails (S0390)
Routine foot care also includes the debridement of mycotic nails, S0390. This service is the temporary reduction in the size or girth of an abnormal nail plate, short of avulsion. It is performed most commonly without anesthesia to: (1) relieve pain; (2) treat infection (bacterial, fungal, or viral); (3) temporarily remove an anatomic deformity such as onychauxis (thickened nail), or certain types of onychocryptosis (ingrown nail); (4) expose subungual conditions for the purpose of treatment as well as diagnosis (biopsy, culture, etc.); (5) prevent further problems, such as subungual ulceration in an insensate patient with onychauxis. |