For those in podiatric medicine, especially those who dispense wound dressings, this simple rule is not complicated and in fact is rather ob-vious. Debridement, either mechani-cal or chemical, must be documented as a part of the wound treatment reg-imen. If you are treating wounds rou-tinely without debridement, this falls below the standard of care for wound treatment.
Full Answer
Does Medicare cover wound care?
Medicare coverage for wound care on a continuing basis, for a given wound, in a given patient, is contingent upon evidence documented in the patient's medical record that the wound is improving in response to the wound care being provided. Evidence of improvement may include measurable changes in the following:
What does Medicare cover for foot care?
Foot care Medicare Part B (Medical Insurance) covers podiatrist (foot doctor), foot exams or treatment if you have diabetes-related nerve damage or need Medically necessary treatment for foot injuries or diseases, like hammer toe, bunion deformities, and heel spurs. Your costs in Original Medicare
When is routine foot care considered medically necessary?
Routine foot care services are considered medically necessary once (1) in 60 days. Other Medicare Contractor’s Local Coverage Determinations. This LCD is being revised in order to adhere to CMS requirements per Chapter 13, Section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs.
What are the documentation requirements for wound care?
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient. The patient's medical record should indicate the specific signs/symptoms and other clinical data supporting the wound care provided.
How often will Medicare pay to have your toenails cut?
once every 61 daysMedicare will cover the treatment of corns, calluses, and toenails once every 61 days in persons having certain systemic conditions.
Are wound supplies covered by Medicare?
Medicare Coverage for Wound Care and Supplies. Original Medicare covers wound care provided in inpatient and outpatient settings. Medicare pays for medically necessary supplies ordered by your doctor. Medicare Part C must provide at least the same amount of coverage as original Medicare, but costs will vary by plan.
Is Wound Care considered DME?
Because negative pressure wound therapy pumps and supplies are considered DME by Medicare, the qualified healthcare professional is not required to supply the equipment, canisters, dressings, etc.
What does Medicare considered routine foot care?
Routine foot care includes: Cutting or removing corns and calluses. Trimming, cutting, or clipping nails. Hygienic or other preventive maintenance, like cleaning and soaking your feet.
Does Medicare pay for daily wound care?
Medicare covers wound care supplies or surgical dressings when they are medically necessary. Medicare will pay for 80 percent of the cost after you meet your deductible. You will also pay a copayment if you receive treatment in a hospital outpatient setting.
What is considered skilled wound care?
“To be considered a skilled service, the service must be so inherently complex that it can be safely and effectively performed only by, or under the supervision of, professional or technical personnel as provided by regulation, including 42 CFR §409.32.
How do you code Wound Care?
The wound care (97597-97598) and debridement codes (11042-11047) are used for debridement of wounds that are intended to heal by secondary intention.
What are the coding guidelines for debridement?
1. Debridement of a wound, performed before the application of a topical or local anesthesia is billed with CPT codes 11042 - 11047. Wound debridements (11042-11047) are reported by depth of tissue that is removed and by surface area of the wound.
Is wound vac included in debridement?
Clinicians commonly use vacuum assisted closure (VAC) devices as adjunctive therapy after wound debridement. The two codes for the application of the VAC device are: CPT 97605 for a wound diameter of less than or equal to 50 cm² and CPT 97606 for wounds greater than 50 cm².
Does Medicare cover callus removal?
Medicare pays for services, items, and tests that are medically necessary in order to maintain good health. Foot care services that Medicare may not cover include: cutting or trimming of the nails (except for people with diabetes who have thick nails) removing corns and calluses.
Is toenail fungus covered by Medicare?
Medicare will cover treatment for fungus within your toenail. Another term for this treatment is nail debridement. To be eligible, you must have severe, debilitating pain. Evidence of several infections caused by the fungus may also qualify you.
Does Medicare cover debridement of nails?
Medicare will cover debridement of nail(s) by any method(s); 1 to 5 and/or debridement of nail(s) by any method(s); 6 or more no more often than every 60 days.
What does a foot doctor cover?
covers podiatrist (foot doctor), foot exams or treatment if you have diabetes-related nerve damage or need. medically necessary. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
What is original Medicare?
Your costs in Original Medicare. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.
What is medically necessary?
medically necessary. Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine. treatment your doctor provides, and the Part B. deductible.
Document Information
CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for wound care. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD.
Coverage Guidance
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits. History/Background and/or General Information This LCD does not address specific wound care procedures described by NCD’s and other items such as:
What is the scope of podiatry?
The scope of the practice for podiatry is defined by state law; therefore, individual state laws should be followed in determining a specific podiatrist’s (or doctor of podiatric medicine) scope of practice.
What type of therapy is used for venous ulcers?
CMS covers the use of electrical stimulation and electromagnetic therapy for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers when certain conditions are met.
Is foot care covered by Medicare?
Certain foot care related services are not generally covered by Medicare. In general, the following services, whether performed by a podiatrist, osteopath, or doctor of medi-cine, and without regard to the difficulty or complexity of the procedure, are not covered by Medicare:
Does Medicare cover orthotics?
Generally, Medicare will not cover orthopedic shoes and other supportive devices for the feet, unless it is an integral part of a leg brace and its expense is included as part of the cost of the brace. Also, a narrow exception permits coverage of thera-peutic shoes and inserts for certain patients with diabetes.
Document Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Title XVIII of the Social Security Act, §1862 (a) (1) (A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
Coverage Guidance
Background Generally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare include the following, regardless of the provider rendering the service:
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Routine Foot Care and Debridement of Nails.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
Article Text Refer to Local Coverage Determination (LCD) L38904, Wound and Ulcer Care, for reasonable and necessary requirements. The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code (s) may be subject to National Correct Coding Initiative (NCCI) edits.
ICD-10-CM Codes that Support Medical Necessity
Note: Diagnosis codes are based on the current ICD-10-CM codes that are effective at the time of LCD publication. Any updates to ICD-10-CM codes will be reviewed by Noridian, and coverage should not be presumed until the results of such review have been published/posted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All ICD-10 codes that are not listed in the ICD-10 Codes That Support Medical Necessity section of this policy.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.