I87.099 — Postthrombotic syndrome with other complications of unspecified lower extremity
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
- For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.
- If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.
- Total the number of keratotic lesions debrided and select the most appropriate CPT code 11055-11057 based on that total (example: code 11056 for two to four lesions).
Key Coverage Criteria
- Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
- Coverage requires documented failure of an adequate trial of conservative treatment prior to interventional treatment.
- Treatment is covered for patients with a documented diagnosis of symptomatic varicose veins of the lower extremity.
- Procedures are covered when appropriate diagnostic testing confirms the presence and location of incompetent perforating or saphenous system veins correlating with clinical symptoms.
- Interventional treatment (sclerotherapy, ligation ± stripping, endovenous radiofrequency or laser ablation) is covered if the patient remains symptomatic after a documented six-week trial of conservative therapy (weight reduction, daily exercise, periodic leg elevation, and graduated compression stockings).
- Patient is considered symptomatic when medical record documents one or more of: stasis ulcer of the lower leg, significant pain and edema that interferes with activities of daily living, bleeding from the diseased vessels, recurrent superficial phlebitis, stasis dermatitis, or refractory dependent edema.
5 Active Policies
A52996 — Billing and Coding: Routine Foot Care
J12
L35138 — Routine Foot Care
J12
ANTHEM-CG-SURG-119 — CG-SURG-119 Treatment of Varicose Veins (Lower Extremities)
A57305 — Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of
L34082 — Varicose Veins of the Lower Extremity, Treatment of
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