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L.9.01.401
Foot 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:
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 Blue Cross & Blue Shield of Mississippi 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 other qualifying metabolic, neurologic, or peripheral vascular disease, which can impede healing and can jeopardize life or limb, routine foot care is considered medically necessary.
Benefits will be provided for the following:
Preventive or routine foot care rendered to a Member by a Provider practicing within the scope of licensure and who is approved by Blue Cross & Blue Shield of Mississippi. The Member must have a diagnosis of Diabetes or is receiving treatment for a metabolic, neurologic, or peripheral vascular disease of such severity that performance of services by a non-professional would put the Member at risk. Preventive or routine foot care is limited to one (1) visit per Calendar Year.
Care of corns, bunions, calluses, or debridement of nails rendered to a Member by a provider practicing within the scope of licensure and who is approved by Blue Cross & Blue Shield of Mississippi. The Member must have diagnosis of diabetes with complications of neuropathy, or is receiving treatment for a metabolic, neurologic, or peripheral vascular disease of such severity that performance of services by a non-professional would put the Member at risk, making such care 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.
Diabetes with complications of neuropathy or being treated for a metabolic, neurologic, or peripheral vascular disease of such severity that performance of services by a non-professional would put the Member at risk
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.
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:
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 which require bilateral procedures;
Pediatric foot conditions prior to closure of growth plates; foot conditions or
Congenital conditions such as tarsal coalition, accessory naviculare, and bipartite sesamoids.
Postoperative x-rays of the foot are medically necessary when performing:
Invasive procedures of bones, joints, and/or soft tissue releases which 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 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.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
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.
Medically Necessary is defined as those services, treatments, procedures, equipment, drugs, devices, items or supplies furnished by a covered Provider that are required to identify or treat a Member's illness, injury or Mental Health Disorders, and which Company determines are covered under this Benefit Plan based on the criteria as follows in A through D:
A. consistent with the symptoms or diagnosis and treatment of the Member's condition, illness, or injury; and
B. appropriate with regard to standards of good medical practice; and
C. not solely for the convenience of the Member, his or her Provider; and
D. the most appropriate supply or level of care which can safely be provided to Member. When applied to the care of an Inpatient, it further means that services for the Member's medical symptoms or conditions require that the services cannot be safely provided to the Member as an Outpatient.
For the definition of medical necessity, “standards of good medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. BCBSMS makes no payment for services, treatments, procedures, equipment, drugs, devices, items or supplies which are not documented to be Medically Necessary. The fact that a Physician or other Provider has prescribed, ordered, recommended, or approved a service or supply does not in itself, make it Medically Necessary.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
5/1994: 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.
09/01/2015: Medical policy revised to add ICD-10 codes. Removed the following ICD-9 procedure codes: 77.19, 79.19, and 79.39. Code Reference section updated to make correction: ICD-9 diagnosis code 433.90 changed to 443.9.
06/09/2016: Policy number L.9.01.401 added.
09/30/2016: Code Reference section updated to add the following new ICD-10 diagnoses: E78.00, E78.01, M21.611 - M21.619, M21.621 - M21.629, S99.001K, S99.021K, and S99.031K.
12/30/2016: Code Reference section updated to add new 2017 CPT codes 28291 and 28295.
09/29/2017: Code Reference section updated to add new ICD-10 procedure codes 0QSN342, 0QSP342, 0QSN04Z, 0QSP04Z and ICD-10 diagnosis codes L97.905, L97.906, L97.908, L97.915, L97.916, L97.918, L97.925, L97.926, L97.928, L97.405, L97.406, L97.408, L97.415, L97.416, L97.418, L97.425, L97.426, L97.428, L97.505, L97.506, L97.508, L97.515, L97.516, L97.518, L97.525, L97.526, L97.528, L97.805, L97.806, L97.808, L97.815, L97.816, L97.818, L97.825, L97.826, L97.828, L98.415, L98.416, L98.418, L98.425, L98.426, L98.428, L98.495, L98.496, and L98.498, effective 10/01/2017. Removed deleted ICD-10 diagnosis code E78.0.
09/24/2019: Code Reference section updated to make note of deleted ICD-10 diagnosis code.
12/21/2021: Code Reference section updated to revise code description for ICD-10 diagnosis code M35.03 and to remove deleted ICD-10 diagnosis code D81.3.
09/30/2022: Policy Guidelines updated to change "Nervous/Mental Conditions" to "Mental Health Disorders" and "Medically Necessary" to "medical necessity." Code Reference section updated to add new ICD-10 diagnosis codes E87.20, E87.21, E87.22, and E87.29, effective 10/01/2022.
01/01/2023: Add coverage of routine foot care for Members with a metabolic, neurologic, or peripheral vascular disease of such severity that performance of services by a non-professional would put the Member at risk. Code Reference section updated to add the following ICD-10 diagnosis codes: A30.0 - A30.9, A50.43, D51.0, E51.11, K90.0, K90.1, I73.00 – I73.8, M30.0, M30.2, M30.8, and M31.7.
09/29/2023: Code Reference section updated to add new ICD-10 diagnosis codes E79.89 and E88.810, effective 10/01/2023.
03/15/2024: Policy reviewed; no changes.
03/27/2024: Policy updated to make note of deleted ICD-10 procedure codes.
10/01/2024: Code Reference section updated to add new ICD-10 diagnosis codes E10.A0, E10.A1, and E10.A2.
03/27/2025: Policy reviewed; no changes.
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 Number | Description | ||
CPT-4 | |||
11720 | Debridement of nail(s) by any method(s); one to five | ||
11721 | Debridement of nail(s) by any method(s); six or more | ||
20550 | Injection, tendon sheath, ligament, trigger points, or ganglion cyst | ||
20600 | Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst (eg, fingers, toes) | ||
28001-28899 | Podiatric procedures | ||
73620-73725 | Radiologic examination, foot and toes code range | ||
76977 | Ultrasound bone density measurement and interpretation, peripheral site(s), any method | ||
77071 | Manual application of stress performed by physician for joint radiography, including contralateral joint if indicated | ||
77072 | Bone age studies | ||
77073 | Bone length studies (orthoroentgenogram, scanogram) | ||
77074 | Radiologic examination, osseous survey; limited (eg, for metastases) | ||
77075 | Radiologic examination, osseous survey; complete (axial and appendicular skeleton) | ||
77076 | Radiologic examination, osseous survey, infant | ||
93922-93971 | Extremity arterial studies (including digits) code range | ||
HCPCS | |||
G0127 | Trimming of dystrophic nails, any number | ||
ICD-9 Procedure | ICD-10 Procedure | ||
77.18 | Other incision of tarsals and metatarsals without division | 0Q9L00Z, 0Q9L0ZZ, 0Q9L30Z, 0Q9L3ZZ, 0Q9M00Z, 0Q9M0ZZ, 0Q9M30Z, 0Q9M3ZZ, 0Q9N00Z, 0Q9N0ZZ, 0Q9N30Z, 0Q9N3ZZ, 0Q9P00Z, 0Q9P0ZZ, 0Q9P30Z, 0Q9P3ZZ 0QWL04Z, 0QWL05Z, 0QWL34Z, 0QWL35Z, 0QWM04Z, 0QWM05Z, 0QWM34Z, 0QWM35Z, 0QWN04Z, 0QWN05Z, 0QWN34Z, 0QWN35Z | Drainage of lower bones, (by body part), by approach (open or percutaneous), and by device Revision of fixation device (internal or external) in lower bones (by body part), and by approach (open or percutaneous) |
77.28 | Wedge osteotomy, tarsals and metatarsals | 0Q8L0ZZ, 0Q8M0ZZ, 0Q8N0ZZ, 0Q8P0ZZ | Division of tarsal or metatarsal (right or left), open approach |
77.38-77.39 | Other division of bone, tarsals and metatarsals, phalanges code range | 0Q8L0ZZ, 0Q8M0ZZ, 0Q8N0ZZ, 0Q8P0ZZ, 0Q8Q0ZZ, 0Q8R0ZZ | Division of toe phalanx (right or left), open approach |
79.17 | Closed reduction of fracture of tarsals and metatarsals with internal fixation | 0QSL34Z | Reposition right tarsal with internal fixation device, percutaneous approach |
0QSM34Z | Reposition left tarsal with internal fixation device, percutaneous approach | ||
0QSN34Z, 0QSN342 | Reposition right metatarsal with internal fixation device, percutaneous approach | ||
0QSP34Z, 0QSP342 | Reposition left metatarsal with internal fixation device, percutaneous approach | ||
79.18 | Closed reduction of fracture of phalanges of foot with internal fixation | 0QSQ34Z 0QSR34Z | Reposition right toe phalanx with internal fixation device, percutaneous approach Reposition left toe phalanx with internal fixation device, percutaneous approach |
79.37 | Open reduction of fracture of tarsals and metatarsals with internal fixation | 0QSL04Z 0QSM04Z 0QSN04Z, 0QSN042 0QSP04Z, 0QSP042 | Reposition right tarsal with internal fixation device, open approach Reposition left tarsal with internal fixation device, open approach Reposition right metatarsal with internal fixation device, open approach Reposition left metatarsal with internal fixation device, open approach |
79.38 | Open reduction of fracture of phalanges of foot with internal fixation | 0QSQ04Z 0QSR04Z | Reposition right toe phalanx with internal fixation device, open approach Reposition left toe phalanx with internal fixation device, open approach |
79.78 | Closed reduction of dislocation of foot and toe | 0SSH34Z, 0SSH35Z, 0SSH3ZZ, 0SSHX4Z, 0SSHX5Z, 0SSHXZZ, 0SSJ34Z, 0SSJ35Z, 0SSJ3ZZ, 0SSJX4Z, 0SSJX5Z, 0SSJXZZ, 0SSK34Z, 0SSK35Z, 0SSK3ZZ, 0SSKX4Z, 0SSKX5Z, 0SSKXZZ, 0SSL34Z, 0SSL35Z, 0SSL3ZZ, 0SSLX4Z, 0SSLX5Z, 0SSLXZZ, 0SSM34Z, 0SSM35Z, 0SSM3ZZ, 0SSMX4Z, 0SSMX5Z, 0SSMXZZ, 0SSN34Z, 0SSN35Z, 0SSN3ZZ, 0SSNX4Z, 0SSNX5Z, 0SSNXZZ, 0SSP34Z, 0SSP35Z, 0SSP3ZZ, 0SSPX4Z, 0SSPX5Z, 0SSPXZZ, 0SSQ34Z, 0SSQ35Z, 0SSQ3ZZ, 0SSQX4Z, 0SSQX5Z, 0SSQXZZ | Reposition of lower joints, (by body part), by approach (external or percutaneous), and by device (internal, external, or no device) |
79.88 | Open reduction of dislocation of foot and toe | 0SSH04Z, 0SSH05Z, 0SSH0ZZ, 0SSJ04Z, 0SSJ05Z, 0SSJ0ZZ, 0SSK04Z, 0SSK05Z, 0SSK0ZZ, 0SSL04Z, 0SSL05Z, 0SSL0ZZ, 0SSM04Z, 0SSM05Z, 0SSM0ZZ, 0SSN04Z, 0SSN05Z, 0SSN0ZZ, 0SSP04Z, 0SSP05Z, 0SSP0ZZ, 0SSQ04Z, 0SSQ05Z, 0SSQ0ZZ | Reposition of lower joints, by body part, and by device (internal, external, or no device), open approach |
80.18 | Other arthrotomy of foot and toe | 0M9S00Z, 0M9S0ZZ, 0M9S30Z, 0M9T00Z, 0M9T0ZZ, 0M9T30Z, 0M9T40Z 0S9H0ZZ, 0S9J00Z, 0S9J0ZZ, 0S9K00Z, 0S9K0ZZ, 0S9L00Z, 0S9L0ZZ, 0S9M00Z, 0S9M0ZZ, 0S9N00Z, 0S9N0ZZ, 0S9P00Z, 0S9P0ZZ, 0S9Q00Z, 0S9Q0ZZ | Drainage of foot bursa and ligament with drainage device, by approach Drainage of lower joints, (by body part), and by device, open approach |
81.91 | Arthrocentesis | 0S9H30Z, 0S9H3ZZ, 0S9J30Z, 0S9J3ZZ, 0S9K30Z, 0S9K3ZZ, 0S9L30Z, 0S9L3ZZ, 0S9M30Z, 0S9M3ZZ, 0S9N30Z, 0S9N3ZZ, 0S9P30Z, 0S9P3ZZ, 0S9Q30Z, 0S9Q3ZZ | Drainage of lower joints, (by body part), and device, percutaneous approach |
81.92 83.96 | Injection of therapeutic substance into joint or ligament Injection of therapeutic substance into bursa | 3E0U3GC | Introduction of other therapeutic substance into joints, percutaneous approach |
83.49 | Other excision of soft tissue | 0JBQ0ZZ | Excision of right foot subcutaneous tissue and fascia, open approach |
0JBQ3ZZ | Excision of right foot subcutaneous tissue and fascia, percutaneous approach | ||
0JBR0ZZ | Excision of left foot subcutaneous tissue and fascia, open approach | ||
0JBR3ZZ | Excision of left foot subcutaneous tissue and fascia, percutaneous approach | ||
83.97 | Injection of therapeutic substance into tendon | 3E023GC | Introduction of other therapeutic substance into muscle, percutaneous approach |
84.10 | Lower limb amputation, not otherwise specified | 0Y6H0Z3, 0Y6J0Z3 | Detachment at lower leg (right or left), low, open approach |
84.11 | Amputation of toe | 0Y6P0Z0, 0Y6P0Z1, 0Y6P0Z2, 0Y6P0Z3, 0Y6Q0Z0, 0Y6Q0Z1, 0Y6Q0Z2, 0Y6Q0Z3, 0Y6R0Z0, 0Y6R0Z1, 0Y6R0Z2, 0Y6R0Z3, 0Y6S0Z0, 0Y6S0Z1, 0Y6S0Z2, 0Y6S0Z3, 0Y6T0Z0, 0Y6T0Z1, 0Y6T0Z2, 0Y6T0Z3, 0Y6U0Z0, 0Y6U0Z1, 0Y6U0Z2, 0Y6U0Z3, 0Y6V0Z0, 0Y6V0Z1, 0Y6V0Z2, 0Y6V0Z3, 0Y6W0Z0, 0Y6W0Z1, 0Y6W0Z2, 0Y6W0Z3, 0Y6X0Z0, 0Y6X0Z1, 0Y6X0Z2, 0Y6X0Z3, 0Y6Y0Z0, 0Y6Y0Z1, 0Y6Y0Z2, 0Y6Y0Z3 (0Y6P0Z2, 0Y6Q0Z2 Deleted 03/31/2024) | Detachment of toe, open approach, (by body part), and qualifier (complete, high, mid or low) |
84.12 | Amputation through foot | 0Y6M0Z4, 0Y6M0Z5, 0Y6M0Z6, 0Y6M0Z7, 0Y6M0Z8, 0Y6M0Z9, 0Y6M0ZB, 0Y6M0ZC, 0Y6M0ZD, 0Y6M0ZF, 0Y6N0Z4, 0Y6N0Z5, 0Y6N0Z6, 0Y6N0Z7, 0Y6N0Z8, 0Y6N0Z9, 0Y6N0ZB, 0Y6N0ZC, 0Y6N0ZD, 0Y6N0ZF | Detachment of foot, open approach, (by body part), and qualifier |
84.13 | Disarticulation of ankle | 0Y6M0Z0, 0Y6N0Z0 | Detachment at foot (right or left), complete, open approach |
86.27 | Debridement of nail, nail bed, or nail fold | 0HBRXZZ | Excision of toe nail, external approach |
88.28 | Skeletal x-ray of ankle and foot | BQ0GZZZ | Plain radiography of right ankle |
BQ0HZZZ | Plain radiography of left ankle | ||
BQ0JZZZ | Plain radiography of right calcaneus | ||
BQ0KZZZ | Plain radiography of left calcaneus | ||
BQ0LZZZ | Plain radiography of right foot | ||
BQ0MZZZ | Plain radiography of left foot | ||
BQ0PZZZ | Plain radiography of right toe(s) | ||
BQ0QZZZ | Plain radiography of left toe(s) | ||
BQ1GZZZ | Fluoroscopy of right ankle | ||
BQ1HZZZ | Fluoroscopy of left ankle | ||
BQ1JZZZ | Fluoroscopy of right calcaneus | ||
BQ1KZZZ | Fluoroscopy of left calcaneus | ||
BQ1LZZZ | Fluoroscopy of right foot | ||
BQ1MZZZ | Fluoroscopy of left foot | ||
BQ1PZZZ | Fluoroscopy of right toe(s) | ||
BQ1QZZZ | Fluoroscopy of left toe(s) | ||
BQ1XZZZ | Fluoroscopy of right foot/toe joint | ||
BQ1YZZZ | Fluoroscopy of left foot/toe joint | ||
88.29 | Skeletal x-ray of lower limb, not otherwise specified | BW0CZZZ | Plain radiography of lower extremity |
88.33 | Other skeletal x-ray | BW0MZZZ | Plain radiography of infant whole body |
88.37 | Other soft tissue x-ray of lower limb | BW1CZZZ | Fluoroscopy of lower extremity |
88.39 | X-ray, other and unspecified | B41FZZZ | Fluoroscopy of right lower extremity arteries |
B41GZZZ | Fluoroscopy of left lower extremity arteries | ||
B41JZZZ | Fluoroscopy of other lower arteries | ||
88.77 | Diagnostic ultrasound of peripheral vascular system | B44FZZZ | Ultrasonography of Right Lower Extremity Arteries |
B44GZZZ | Ultrasonography of left lower extremity arteries | ||
B44HZZZ | Ultrasonography of bilateral lower extremity arteries | ||
89.58 | Plethysmogram | 4A02X9Z | Measurement of cardiac output, external approach |
98.28 | Removal of foreign body from foot without incision | 0HCMXZZ, 0HCNXZZ 0HCRXZZ | Extirpation of matter from foot skin (right or left), external approach Extirpation of matter from toe nail, external approach |
ICD-9 Diagnosis | ICD-10 Diagnosis | ||
A30.0 - A30.9 | Leprosy | ||
A50.43 | Late congenital syphilitic polyneuropathy | ||
110.1 | Onychomycosis | B35.1 | Tinea unguium |
249.00 - 249.91 | Secondary diabetes | E08.00 - E08.9 | Diabetes mellitus due to underlying conditions |
E09.00 - E09.9 | Drug or chemical induced diabetes mellitus | ||
E13.00 - E13.9 | Other specified diabetes mellitus | ||
250.00 - 250.93 | Diabetes mellitus code range (must be used with another code to specify the circulatory disorder) | E10.10 - E10.9 | Type 1 diabetes mellitus |
E10.A0, E10.A1, E10.A2 | Type 1 diabetes mellitus, presymptomatic (New 10/01/2024) | ||
E11.00 - E11.9 | Type 2 diabetes mellitus | ||
E13.00 - E13.9 | Other specified diabetes mellitus | ||
270.0 - 277.9 | Metabolic disease code range | C88.0 | Waldenstrom macroglobulinemia |
C96.5 | Multifocal and unisystemic Langerhans-cell histiocytosis | ||
C96.6 | Unifocal Langerhans-cell histiocytosis | ||
D47.2 | Monoclonal gammopathy | ||
D51.0 | Vitamin B12 deficiency anemia due to intrinsic factor deficiency | ||
D81.5, D81.810 | Combined immunodeficiencies | ||
D84.1 | Defects in the complement system | ||
D89.0 - D89.2 | Other disorders involving the immune mechanism, not elsewhere classified | ||
E51.11 | Dry beriberi | ||
E70.0 - 70.9; E71.9 - E71.548; E72.0 - E72.9; E73.0 - E73.9; E74.00 - E74.9; E75.21 - E75.249; E75.3, E75.5, E75.6, E76.01 - E76.9; E77.0 - E77.9; E78.00 - E78.70, E78.79, E78.81, E78.89, E78.9; E79.1 - E79.9; E83.00 - E83.19, E83.30 - E83.9; E84.0 - E84.9; E85.0 - E85.9; E86.0 - E86.9; E87.0 - E87.8; E88.01 - E88.9 | Metabolic disorders code range | ||
E87.20 | Acidosis, unspecified | ||
E87.21 | Acute metabolic acidosis | ||
E87.22 | Chronic metabolic acidosis | ||
E87.29 | Other acidosis | ||
H49.811 - H49.819 | Kearnes-Sayre syndrome | ||
M10.00 - M10.9 | Gout code range | ||
M1A.00x - M1A.9xx | Chronic Gout code range | ||
320.0 - 359.9 | Neurologic disease code range | A52.15 | Late syphilitic neuropathy |
B45.1 | Cerebral cryptococcosis | ||
E75.00 - E75.19, E75.23, E75.25, E75.29, E75.4 | Other sphingolipidosis | ||
F51.04, F51.05, F51.13, F51.19 | Sleep disorders not due to substance or known | ||
F84.2 | Rett's syndrome | ||
G00.0 - G99.8 | Diseases of the nervous system | ||
I67.83 | Posterior reversible encephalopathy syndrome | ||
M05.071 - M05.079 | Felty's syndrome, ankle and foot | ||
M05.571 - M05.579 | Rheumatoid myopathy with rheumatoid arthritis of ankle and foot | ||
M33.02, M33.12, M33.22, M33.92 | Dermatopolymyositis | ||
M34.82, M34.83 | Other forms of systemic sclerosis | ||
M35.03 | Sjogren syndrome with myopathy | ||
R52 | Pain, unspecified | ||
S06.1x0 - S06.1x9 | Traumatic cerebral edema | ||
414.00 - 414.05 | Coronary atherosclerosis code range | I25.10 - I25.119 | Atherosclerotic heart disease of native coronary, with or without angina pectoris |
I25.700 - I25.739, I25.790 - I25.799 | Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris | ||
I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris | ||
429.2 | Cardiovascular disease, unspecified (includes arteriosclerotic disease) | I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
443.9 | Intermittent claudication | I73.00 - I73.9 | Peripheral vascular disease |
440.20 - 440.29 | Arteriosclerosis of native arteries of the extremities, code range | I70.201 - I70.299 | Atherosclerosis of native arteries of the extremities code range |
440.9 | Generalized and unspecified atherosclerosis (includes arteriosclerosis obliterans) | I70.90, I70.91 | Unspecified or generalized atherosclerosis |
443.0 - 443.9 | Other peripheral vascular disease code range | I67.0 | Dissection of cerebral arteries, nonruptured |
I73.00 - I73.9 | Raynaud's syndrome | ||
I77.71 - I77.79 | Other arterial dissection | ||
I79.1 | Aortitis in diseases classified elsewhere | ||
I79.8 | Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere | ||
457.1 | Lymphedema secondary to specific disease, e.g., Milroy's disease, malignancy | I89.0 | Lymphedema, not elsewhere classified |
459.81 | Unspecified venous (peripheral) insufficiency | I87.2 | Venous insufficiency (chronic) (peripheral) |
K90.0 | Celiac disease | ||
K90.1 | Tropical sprue | ||
681.11 | Onychia and paronychia of toe | L03.031, L03.032, L03.039 | Cellulitis of toe |
682.9 | Chronic indurated cellulitis | L03.90 | Cellulitis, unspecified |
700 | Corns and callosities | L84 | Corns and callosities |
703.0 | Ingrowing nail | L60.0 | Ingrowing nail |
703.8 | Other specified diseases of nail (includes onychauxis, onychogryphosis, onogryphosis) | L60.1, L60.2, L60.3, L60.4, L60.5, L60.8 | Nail disorders |
L62 | Nail disorders in diseases classified elsewhere | ||
703.9 | Unspecified disease of nail | L60.9 | Nail disorder, unspecified |
707.10 | Ulcer of lower limbs, except decubuitus (includes ischemic ulcer) | L97.901 - L97.929 | Non-pressure chronic ulcer of unspecified part of lower leg |
707.14 | Ulcer of heel and midfoot | L97.401 - L97.429 | Non-pressure chronic ulcer of heel and midfoot |
707.15 | Ulcer of other part of foot | L97.501 - L97.529 | Non-pressure chronic ulcer of other part of foot |
707.19 | Ulcer of other part of lower limb | L97.801 - L97.829 | Non-pressure chronic ulcer of other part of lower leg |
707.8 | Chronic ulcer of other specified site | L98.411 - L98.429 | Non-pressure chronic ulcer of skin, not elsewhere classified |
707.9 | Chronic ulcer of unspecified site | L98.491 - L98.499 | Non-pressure chronic ulcer of skin of other sites |
709.00 | Dyschromia, unspecified | L81.9 | Disorder of pigmentation, unspecified |
709.1 | Vascular disorder of skin | L81.7 | Pigmented purpuric dermatosis |
709.3 | Degenerative skin disorder | L92.1 | Necrobiosis lipoidica, not elsewhere specified |
L94.2 | Calcinosis cutis | ||
L98.8 | Other specified disorders of the skin and subcutaneous tissue | ||
709.8 | Other specified disorder of skin | L44.8 | Other specified papulosquamous disorders |
L44.9 | Papulosquamous disorder, unspecified | ||
L45 | Papulosquamous disorders in diseases classified elsewhere | ||
L94.4 | Gottron's papules | ||
L99 | Other disorders of skin and subcutaneous tissue in diseases classified elsewhere | ||
709.9 | Unspecified disorder of skin and subcutaneous tissue | L98.9 | Disorder of the skin and subcutaneous tissue, unspecified |
718.36 | Recurrent dislocation of lower leg joint | M22.00 - M22.02 | Recurrent dislocation of patella |
M22.10 - M22.12 | Recurrent subluxation of patella | ||
M24.461 - M24.469 | Recurrent dislocation of knee | ||
718.37 | Recurrent dislocation of ankle and foot joint | M24.471 - M24.479 | Recurrent dislocation, ankle, foot and toes |
727.1 | Bunion Note: See policy limitations in the POLICY section. | M20.10 | Hallux valgus (acquired), unspecified foot |
M21.611 - M21.619 | Bunion | ||
M21.621 - M21.629 | Bunionette | ||
M30.0, M30.2, M30.8 | Polyarteritis | ||
M31.7 | Microscopic polyangitis | ||
729.5 | Foot pain | M79.671 - M79.676 | Pain in foot and toes |
733.81 | Malunion of fracture | S92.001P - S92.919P | Fracture of foot and toe, except ankle (the appropriate 7th character "P" is to be added to each code from category S92. |
M80.071P - M80.079P | Age-related osteoporosis with current pathological fracture, ankle and foot | ||
M80.871P - M80.879P | Other osteoporosis with current pathological fracture, ankle and foot | ||
M84.371P - M84.379P | Stress fracture, ankle, foot and toes | ||
M84.471P - M84.479P | Pathological fracture, ankle, foot and toes | ||
M84.571P - M84.576P | Pathological fracture in neoplastic disease, ankle and foot | ||
M84.671P - M84.676P | Pathological fracture in other disease, ankle and foot | ||
733.82 | Nonunion of fracture | S92.001K - S92.919K | Fracture of foot and toe, except ankle (the appropriate 7th character "K" is to be added to each code from category S92) |
M80.071K - M80.079K | Age-related osteoporosis with current pathological fracture, ankle and foot (the appropriate 7th character "K" is to be added to each code from category S92) | ||
M80.871K - M80.879K | Other osteoporosis with current pathological fracture, ankle and foot (the appropriate 7th character "K" is to be added to each code from category S92) | ||
M84.371K - M84.379K | Stress fracture, ankle, foot and toes (the appropriate 7th character "K" is to be added to each code from category S92) | ||
M84.471K - M84.479K | Pathological fracture, ankle, foot and toes (the appropriate 7th character "K" is to be added to each code from category S92) | ||
M84.571K - M84.576K | Pathological fracture in neoplastic disease, ankle and foot (the appropriate 7th character "K" is to be added to each code from category S92) | ||
M84.671K - M84.676K | Pathological fracture in other disease, ankle and foot (the appropriate 7th character "K" is to be added to each code from category S92) | ||
755.66 | Other congenital anomaly of toes | Q66.89 | Other specified congenital deformities of feet |
755.67 | Congenital anomalies of foot, not elsewhere classified | Q72.70 | Split foot, unspecified lower limb |
755.69 | Other congenital anomaly of lower limb, including pelvic girdle | Q74.2 | Other congenital malformations of lower limb(s), including pelvic girdle |
782.3 | Intractable edema secondary to specific disease e.g., congestive heart failure (CHF), Kidney disease, hyperthyroidism | R60.0, R60.1, R60.9 | Edema, not elsewhere specified |
825.0 - 826.1 | Fracture of one or more tarsal and metatarsal bones/Fracture of one or more phalanges of foot code range | S92.001 - S92.919 | Fracture of foot and toe, except ankle (the appropriate 7th character "A" or "B" is to be added to each code from category S92. |
S99.001K | Unspecified physeal fracture of right calcaneus, subsequent encounter for fracture with nonunion | ||
S99.021K | Salter-Harris Type II physeal fracture of right calcaneus, subsequent encounter for fracture with nonunion | ||
S99.031K | Salter-Harris Type III physeal fracture of right calcaneus, subsequent encounter for fracture with nonunion | ||
838.00 - 838.19 | Dislocation of foot code range | S93.101 - S93.336 | Dislocation of joints and ligaments at foot and toe level (The appropriate 7th character is to be added to each code from category S93) |
892.0 - 892.2 | Open wound of foot except toe(s) alone code range | S91.301 - S91.359 S96.929 | Open wound of foot Laceration of unspecified muscle and tendon at ankle and foot level, unspecified foot |
893.0 - 893.2 | Open wound of toe(s) code range | S91.101 - S91.259 | Open wound of toe without damage to nail |
V49.70 | Lower limb amputation status, unspecified level | Z89.9 | Acquired absence of limb, unspecified |
V49.71 | Lower limb amputation status, great toe | Z89.411, Z89.412, Z89.419 | Acquired absence of great toe |
V49.72 | Lower limb amputation status, other toes | Z89.421, Z89.422, Z89.429 | Acquired absence of other toe(s) |
V49.73 | Lower limb amputation status, foot | Z89.431, Z89.432, Z89.439 | Acquired absence of foot |
V54.0 | Aftercare involving removal of fracture plate or other internal fixation device | Z47.2 | Encounter for removal of internal fixation device |
V54.8 | Other orthopedic aftercare (Kirschner wire) | Z47.81, Z47.82, Z47.89 | Encounter for other orthopedic aftercare |
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