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11721 - NAIL CARE

Vera Posted Fri 22nd of March, 2013 18:01:35 PM

When coding nail care, it's been my understanding that the patient with a systemic disease, getting nail care, must have a face to face visit with their Dr within the last six months, or the nail care cannot be done?

If that is still the case, - many people see nurse practitioners and P.A's here in Montana. Do they still HAVE to be seeing an MD to get the nail care done ?

SuperCoder Answered Mon 25th of March, 2013 15:41:20 PM

The following article will help you:

http://health-information.advanceweb.com/Columns/Coding-Corner/Pearls-to-Auditing-Nail-Care-Services.aspx

Thanks.

Vera Posted Mon 25th of March, 2013 19:16:23 PM

I read the article twice, and no where in the article does it address my initial questions. It gave me a good run down of billing nail care properly, but again, the questions I originally asked (below) - were not even touched on.

#1 When coding nail care, it's been my understanding that the patient with a systemic disease, getting nail care, must have a face to face visit with their Dr within the last six months, or the nail care cannot be done?

#2 If that is still the case, - many people see nurse practitioners and P.A's here in Montana. Do they still HAVE to be seeing an MD to get the nail care done ?

Thank you!

SuperCoder Answered Tue 02nd of April, 2013 04:51:23 AM

My editor views on the topic :

#1 The facts of the 1st statement is correct.

#2 My understanding is that the PA or NP can see the patient but their must be an NPI provided

Thanks

Vera Posted Wed 03rd of April, 2013 17:37:42 PM

#2 --- ? Your understanding ? This service is something we paid for in order to get solid answers - or at the very least pointed in the direction to articles/LCD's - something more than an "understanding" that give us the actual Medicare answer - because "my understanding" is that is MUST be an MD ?

SuperCoder Answered Thu 04th of April, 2013 11:04:00 AM

Please see the last 2 Q&A in the given link of WPS Medicare website: http://www.wpsmedicare.com/part_b/faqs/departmental/podiatry_faq.shtml#pcq5

According to this, any podiatrist or PCP can perform a F-2-F visit for the patient within the 6 months when there is a systemic condition. In case of certain systemic diseases, routine procedures are covered only if the patient is under the active care of a doctor of medicine (M.D.) or osteopathy (D.O.) who documents the condition. The list of systemic conditions is provided within the page and the * marked ones are the ones when an MD/DO is must.

P # 15-16 of the Medicare "foot care guide" manual supports this too: http://www.medicarenhic.com/providers/pubs/Foot%20Care%20Billing%20Guide.pdf

Vera Posted Thu 04th of April, 2013 22:12:42 PM

Thank you for your reply - it is very frustrating trying to figure out all the convoluted rules to billing podiatry. Your reply did not exactly answer my question, but it did provide me with much useful information .... the problem in montana is there are so many nurse practioners and P.A.'s, that much of the elderly population see them for primary care, ...and from what i see, if you have a systemic disease, you HAVE to see an MD or DO. That creates a problem here - either we tell these people they have to switch primary care providers, or stop seeing the patient. Very frustrating.....

Again, thank you for the information.

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