Routine foot care is defined as the cutting or removal of corns or calluses; trimming of toenails; other hygienic, preventive maintenance care included in self-care (such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of both ambulatory and non-ambulatory patients), and any services performed in the absence of localized disease, injury or symptoms involving the foot.
Nail debridement involves the significant reduction in the thickness and length of the toe nail with the aim of allowing the patient to ambulate without pain. Simple trimming of the end of the toenails by cutting or grinding is not considered debridement. Reduction in the length of normal or thickened elongated toenails (whether done with an electric burr or by hand) is not considered debridement. Similarly, buffing the surface or the edges of manually trimmed mycotic toenails (mycotic=fungal infection) is not considered debridement.
Routine foot care and nail debridement are generally non-covered services. In addition, any treatment of a fungal (mycotic) infection of the toenail is considered routine and not covered unless there is clinical evidence of fungal infection of the toe nail, and strong medical evidence documenting that the patient either has a limitation with ambulation that requires active treatment of the foot, or if non-ambulatory, the patient has a condition that would likely cause significant medical complications without treatment.
Routine foot care and nail debridement may be covered when there are systemic conditions (metabolic, neurological or peripheral vascular diseases) which would result in severe circulatory compromise or areas of diminished sensation in the legs or feet and most likely would slow down healing or jeopardize life or limb.
These systemic conditions could present as non-palpable pulses in the foot, advanced skin changes due to arterial insufficiency, or claudication (leg or calf pain with walking; pain in calf causing limping; cessation of walking secondary to calf pain). In these instances, certain foot care procedures that would otherwise be considered routine may pose a hazard when performed by the patient or other nonprofessional person.