More frequent visits yield better results if requirements are met
By Tolu Ajiboye
Foot disorders and pain are extremely common in the elderly. Many studies suggest that about 71% to 87% of older patients have at least one foot disorder. Another study goes further to report that at least one in four older people are affected by foot pain.
Many among the elderly rely on some form of routine foot care to alleviate discomfort and prevent ambulatory limitations caused by foot disorders and pain.
Routine foot care is typically not covered by Medicare- only medically necessary and reasonable foot care services are. According to the Centers for Medicare and Medicaid Services (CMS), the following services are considered routine and are not covered:
⦁ “The cutting or removal of corns and calluses
⦁ The trimming, cutting, clipping, or debridement of nails
⦁ Other hygienic and preventive maintenance care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of either ambulatory or bedfast patients, and any other service performed in the absence of localized illness, injury, or symptoms involving the foot”
Medicare, however, outlines certain circumstances where routine foot care may be covered for a patient. They include:
⦁ If a patient has a systemic condition that requires professional foot care, that would have been labelled routine foot care if the underlying condition was absent. Underlying systemic conditions that may necessitate this type of foot care include, metabolic, neurologic, and peripheral vascular diseases like diabetes, chronic thrombophlebitis, buerger’s disease and arteriosclerosis obliterans. Included are also peripheral neuropathy of the feet associated with carcinomas, drugs and toxins, alcoholism, malnutrition, malabsorption, pernicious anemia, traumatic injury, neurosyphilis or certain hereditary conditions.
For most of these conditions, Medicare will only extend coverage if the patient is “under the active care of a physician or doctor of osteopathy that documents the condition”.
⦁ If the patient has mycotic nails, treatment of which ordinarily involves some form of routine foot care. Coverage of mycotic nail treatment for patients who can still walk is dependent on the availability of clinical evidence of mycosis and physician documentation of the patient suffering movement limitations, pain or a secondary infection as a result of it. For non-ambulatory patients (patient’s who can no longer walk), clinical evidence must also be documented by the physician as well as proof that the mycosis is causing pain or a secondary infection.
How ASAP Lab can help
ASAP Lab can help you with the process of obtaining clinical evidence of mycosis- one of the conditions whose presence may trigger routine foot care coverage by Medicare. Medicare will presume coverage when clinical findings are consistent with your diagnosis. This is where ASAP Lab comes in.
Using the Polymerase Chain Reaction (PCR) molecular technique, ASAP Lab provides a comprehensive nail fungal panel. Performed with nail clippings, it checks for fungi like dermatophytes and candida, the two major causes of mycosis.
ASAP Lab provides all the testing supplies needed, with options for the kits to be delivered to your practice or to the patient. The results are also available online within 24-48 hours. Get in touch now and see how we can assist you in ensuring that your patients’ eligible routine visits are covered.
For more information on testing for Podiatry as a part of your practice based on medical necessity visit ASAP Lab for a comprehensive list of all its testing services.