Medicare Billing Guidelines for Podiatry – Complicating Conditions Claims
- When submitting claims for services furnished to Medicare beneficiaries who have complicating conditions, the name of the M.D. or D.O. who diagnosed the complicating condition must be submitted with the claim, along with the approximate date that the beneficiary was last seen by the indicated physician.
- Document carefully any convincing evidence showing that non-professional performance of service would have been hazardous for the beneficiary because of an underlying systemic disease. Stating that the beneficiary has a complicating condition such as diabetes does not of itself indicate the severity of the condition.
- Exceptional situations include initial diagnostic services performed in connection with a specific symptom or complaint if it seems likely that its treatment would be covered even though the resulting diagnosis may be one requiring only non-covered care.
- The exclusion of foot care is determined by the nature of the service and not according to who provides the service. When an itemized bill shows both covered services and non-covered services that are not integrally related to the covered service, the portion of the charges that are attributable to the non-covered services should be denied.
- Sometimes payment is made for incidental non-covered services that are performed as a necessary and integral part of, and secondary to, a covered procedure. For example, if toenails must be trimmed in order to apply a cast to a fractured foot, then the charge for the trimming of nails would be covered
- However, a separately itemized charge for this excluded service would not be allowed. Please refer to your Medicare contractor for questions about coverage that is “incident to” a covered procedure.
- Information about coverage Incident to Physician’s Professional Services can also be found in the “Medicare Benefit Policy Manual,” Chapter 15, Covered Medical and Other Health Services, Section 60 – Services and Supplies.
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