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DESCRIPTIONFoot care services are the examination, diagnosis and medical, physical and surgical treatment of conditions and dysfunctions of the human foot.
Foot care services are considered medically necessary when all of the following criteria are met:
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.
In accordance with Mississippi State Senate Bill #2215, benefits will be provided for the following:
Manual debridement and electric grinding procedures of the toenails, when performed by qualified providers, are considered medically necessary only for the following conditions:
Pre-operative, non-invasive vascular studies (Doppler or segmental plethysmography or duplex scan) are considered medically necessary with the following diagnoses, symptoms, or signs:
At a minimum, an injectable local anesthetic must be used in order for a foot care procedure to be considered "toenail surgery."
Nerve blocks performed for the purpose of increasing blood supply to the foot and toes are considered not medically necessary.
Pre-Operative x-rays are medically necessary when performing:
Bilateral x-rays of the feet are medically necessary for:
Postoperative x-rays of the foot are medically necessary when performing :
Contraindications to steroid injections are the development of a vascular 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 are considered not medically necessary without supporting documentation.
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, onychgryposis or onychryptosis (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 which 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.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY5/1994: Approved by Medical Policy Advisory Committee (MPAC)
8/1999: Revisions approved by MPAC
1/29/2002: New code 28289 added
2/27/2001: Hyperlink to therapeutic shoes deleted. Therapeutic shoes policy deleted.
6/4/2002: Code Reference section updated, CPT codes (code range) 11720-11765, 20660-20610, 28800-28825, 99201-99205, 99211-99215, 99241-99245, 99271-99275 deleted, local code M0101 deleted, ICD-9 diagnosis code 757.0 deleted, modifiers 50 and 51 deleted, non-covered table added, ICD-9 diagnosis code 700, 727.1, 734 added non-covered codes
1/11/2005: Code Reference section updated, non-covered table deleted, ICD-9 diagnosis code 700, 727.1 moved to covered table, ICD-9 diagnosis code 734 deleted, non-covered table deleted
10/16/2006: Policy reviewed, no changes
12/28/2006: Code Reference section updated per the 2007 CPT/HCPCS revisions
9/15/2008: Code reference section updated per the annual ICD-9 updates effective 10-1-2008
Research for this policy were compiled using a combination of standard billing practices, local Blue Cross & Blue Shield of Mississippi Plan policies and claims experience.
Uniform Medical Policy Manual (3/1994)
CODE REFERENCEThis is not intended to be a comprehensive list of codes. Some codes may be variable, and coverage will be based on the clinical indication for the service.