11755?

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p100

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On a routine nail clipping sent for culture do you bill 11755? Most everyone I have asked says yes. What does SDN do?
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Fraud. Nail unit = nail bed, matrix, etc. NOT nail clippings.

EDIT: Nail clippings are not adequate for discerning nail pathogens. Need soft tissue adjavent to hyponychium (use currette). Can’t bill for this really, either.
 
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p100 said:
On a routine nail clipping sent for culture do you bill 11755? Most everyone I have asked says yes. What does SDN do?
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That depends. Are you wearing loupes with at least 4.0x mag?
 
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Questions like this really make me wish the government, instead of hiring more IRS workers, instead supercharged their medicare audit teams - cut back on fraud and greatly improve the podiatry over-saturation problem. Win Win. The folks telling you that nail clippings are legitimate for 11755 are the same pods that do those antibiotic foot soaks, or perhaps bill for services that their residents provided (but they "discussed" with).
 
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Good to know. Thanks for the answers.
 
PatchAdamsFan said:
Questions like this really make me wish the government, instead of hiring more IRS workers, instead supercharged their medicare audit teams
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I would happily be a government employee. I’d even take a small pay cut in order to work from home, review charts, type up reports, and I would easily pay for myself doing nothing but reviewing podiatry claims for CMS.

I could go non-clinical in a heart beat. Too bad the opportunities to do so as a DPM are so limited compared to MD/DO and RNs…kinda sad when you think about it
 
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p100 said:
On a routine nail clipping sent for culture do you bill 11755? Most everyone I have asked says yes. What does SDN do?
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Can I ask why you send for culture on a routine nail clipping ? Are you looking for something ?
 
podiatryresident said:
Are you looking for something ?
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Yes, obviously they are looking for something…

And that something is a doctor’s paycheck while performing a pedicurist’s services.
 
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I’m sure if you go to ACFAS this weekend probably 50% of the TFPs will also say yes.

I’m glad you asked and got this clarified before getting into deep trouble down the road.
 
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Last I read on uptodate it’s recommended to treat onychomycosis empirically without biopsy, and then only when it’s recalcitrant do you biopsy. Also I think we don’t need to check lfts anymore. Has it changed?
 
podiatryresident said:
Can I ask why you send for culture on a routine nail clipping ? Are you looking for something ?
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It was poor wording on my part. I should have used only or simply nail clippings.

For ex: a patient wants Terbinafine for nail fungus so you clip the nail and send for testing before giving them the medication. If you simply clip the nail and don't biopsy the matrix or nail bed and don't use local anesthesia.
 
You are going to think I sound obtuse, but why are you bothering to test the nail?

If you think the patient will benefit from terbinafine - prescribe it and skip the $500-700 test.
 
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p100 said:
It was poor wording on my part. I should have used only or simply nail clippings.

For ex: a patient wants Terbinafine for nail fungus so you clip the nail and send for testing before giving them the medication. If you simply clip the nail and don't biopsy the matrix or nail bed and don't use local anesthesia.
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If you are adamant on testing send for a KOH. Testing is not required however, just treat. No billing for the collection of nail for KOH
 
heybrother said:
You are going to think I sound obtuse, but why are you bothering to test the nail?

If you think the patient will benefit from terbinafine - prescribe it and skip the $500-700 test.
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It’s a highly podiatric move.
 
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AttackNME said:
Last I read on uptodate it’s recommended to treat onychomycosis empirically without biopsy, and then only when it’s recalcitrant do you biopsy. Also I think we don’t need to check lfts anymore. Has it changed?
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Warren Joseph just had an aneurysm reading this. How dare you prescribe potentially toxic medicine in <1% of people without confirming with lab data!
 
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HardRoadPaved said:
Warren Joseph just had an aneurysm reading this. How dare you prescribe potentially toxic medicine in <1% of people without confirming with lab data!
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Ok whatever man, I’m not trying to kill people. Just yesterday I gave a patient orders to take Tylenol after I did an extensive total toenail replacement surgery and will check their LFTs closely to watch for liver foie gras
 
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I regularly test toenails using pcr before starting lamisil. Yes it's a byproduct of my own anal retentiveness, I prefer to know what I'm treating. If it's a non dermatophyte mold or candida, I don't bother giving the drug because it's probably a commensal infection and not a true etiology of the nail dystrophy.

I see the argument for just handing over a rx and saying "good luck." But a non-trivial % of the time, it's not a treatable dystrophy (either ndm, candida, or just plain thick nails). Then the pt gets no better, follows up with you or a different doc, and you're asking is this a reinfection or was this ever anything that could be treated.

BTW usually these pts say their toenail hurts a little, so in these instances I bill 11720 for taking the sample
 
A rep from one of the Bako-esque pathology labs sent me this article, which is a link from the CDC's website. We all know the CDC is NEVER wrong

Choosing Wisely: An Initiative of the ABIM Foundation

Choosing Wisely was an 11-year campaign launched by the ABIM Foundation, aimed at promoting conversations between clinicians and patients about unnecessary medical tests, treatments, and procedures. In addition to detailing the initiative's history, the site offers various resources and research...
www.choosingwisely.org
 
“Toenails are serious business.”

-Kim Jong-un
 
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If a toenail looks fungal treat it as fungal. If they don’t get better tell them whatever you want (it wasn’t fungus or it just didn’t work as it often times doesn’t), and then say there is no great treatments other than removing the nail, which most won’t want, and then they go away.

I mean at least get them something from the compounding pharmacy you get kickbacks from if you’re scared of terbinafine, so you can profit a little before they give up on treating their ugly nails…
 
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Adam Smasher said:
I regularly test toenails using pcr before starting lamisil. Yes it's a byproduct of my own anal retentiveness, I prefer to know what I'm treating. If it's a non dermatophyte mold or candida, I don't bother giving the drug because it's probably a commensal infection and not a true etiology of the nail dystrophy.

I see the argument for just handing over a rx and saying "good luck." But a non-trivial % of the time, it's not a treatable dystrophy (either ndm, candida, or just plain thick nails). Then the pt gets no better, follows up with you or a different doc, and you're asking is this a reinfection or was this ever anything that could be treated.

BTW usually these pts say their toenail hurts a little, so in these instances I bill 11720 for taking the sample
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Other than this right here...I have not used the word dermatophyte since school, and hope to not speak that word aloud ever again.
 
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Adam Smasher said:
I regularly test toenails using pcr before starting lamisil. Yes it's a byproduct of my own anal retentiveness, I prefer to know what I'm treating. If it's a non dermatophyte mold or candida, I don't bother giving the drug because it's probably a commensal infection and not a true etiology of the nail dystrophy.

I see the argument for just handing over a rx and saying "good luck." But a non-trivial % of the time, it's not a treatable dystrophy (either ndm, candida, or just plain thick nails). Then the pt gets no better, follows up with you or a different doc, and you're asking is this a reinfection or was this ever anything that could be treated.

BTW usually these pts say their toenail hurts a little, so in these instances I bill 11720 for taking the sample
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Remember to get lots of subungual goodness for your PCR or Tracey Vlahovic will cry
 
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Look I'm sorry I'm not as cool as everyone else, I find infectious disease interesting no matter how banal it is, so I'm going to adhere to the published treatment algorithms, which I also read, and then go level up my WoW character because I'm such a huge nerd.

PS Dermatophyte Dermatophyte Dermatophyte
 
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Adam Smasher said:
Look I'm sorry I'm not as cool as everyone else, I find infectious disease interesting no matter how banal it is, so I'm going to adhere to the published treatment algorithms, which I also read, and then go level up my WoW character because I'm such a huge nerd.

PS Dermatophyte Dermatophyte Dermatophyte
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I have no qualms with your algorithm.

Just like many topics there are differing view points. I actually discussed this with some of the dermatologists when on my rotation in residency. They advocated testing just as you proposed. They however recommended KOH as any other test is way to expensive (cost benefit not there). Their view point is also from the high tower of dealing with nails once a week. They admitted that if they saw 10 a day their tune may be different.
 
"Everyone I have asked" doesn't matter... just read the CPT codes. It's black and white on that one: routine clip is not a biopsy definition.
DYK gave a good link... 11755 is for biopsy a pigmented streak, suspected pyogenic granuloma, slow healing crush injury, etc (think lido, blood, etc).

...I have seen routine foot care bill slips with 11721+ 11755-TA + 11755-T5 + 11730-TA + 11730-T5 (plus obviously all of the path lab codes the doc/group owns later on). It works til it doesn't.

Take home is why be the tallest blade of fraud grass?

ExperiencedDPM said:
100% fraud.
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"It works til it doesn't," huh? :)

dtrack22 said:
If a toenail looks fungal treat it as fungal. If they don’t get better tell them whatever you want (it wasn’t fungus or it just didn’t work as it often times doesn’t), and then say there is no great treatments other than removing the nail, which most won’t want, and then they go away.

I mean at least get them something from the compounding pharmacy you get kickbacks from if you’re scared of terbinafine, so you can profit a little before they give up on treating their ugly nails…
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You are earnestly imploring that DPMs have skills which extend proximal to the IPJ? What heresy to TFP doctorine is this??????

But, uh... yeah, 100% correct.
 
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