L03.039 — Cellulitis of unspecified toe
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high 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.
- Routine foot care is generally excluded from Medicare coverage but may be covered when a systemic condition justifies the need for routine foot care as defined in CMS manuals.
- Coverage may be allowed when the patient has Amyotrophic Lateral Sclerosis (ALS) resulting in a need for routine foot care.
- Coverage may be allowed when the patient has arteritis of the feet resulting in a need for routine foot care.
- Coverage may be allowed when the patient has chronic indurated cellulitis of the feet resulting in a need for routine foot care.
- Coverage may be allowed when the patient has chronic venous insufficiency resulting in a need for routine foot care.
2 Active Policies
A52996 — Billing and Coding: Routine Foot Care
J12
L35138 — Routine Foot Care
J12
Related Codes
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