Cigna ingrown toenails and warts

This is an appropriate question for this section for this forum. And one can expand this to just about any service, is it covered or not? Is it covered for podiatry? Does it need to be referred out to a smaller panel of providers (DME is often carved out).

Your back office should be inquiring on these issues prior to this new patient visit.

As to this question, it really hints on whether or not Cigna is emulating Medicare's stance on non painful warts and ingrown toenails consideration as routine foot care. Bot are typically non covered services, unless the ingrown toenail is covered under the LCD for surgical nails (e.g. CPT 11730) and not tx simply as a slant back or the verrucae is documented as painful (as per the LCD on benign skin lesions).

Hence for the ingrown nail issue, if your diagnosis is simply ingrown toenail (L60.0) and no paronychia (L03.31/2) is reported, this likely will fall as a routine foot care matter and hence be non-covered.

As for the verrucae, you will need to report pain (L79.67X) in addition to the verrucae code of B07.0.

For either of these you may still need to file an appeal to justify that you did more than provide in what the carrier's eyes is routine foot care.

For the toenail that would be e/m with tx with soaks and antibiotics (Rx or OTC) for an infection or under the surgical treatment of nails (e.g. CPT 11730) with the use of local anesthesia (explain if not using due to neuropathy) an operative report and post op care instructions and possible post op visit.

For the verrucae your chart will need to reflect pain due to the location of the verrucae and interference with ambulation. Exactly what was done to treat the verrucae (e.g. debridement, cauterization with ???, etc.).

Either of these may require a lengthy appeals process, even with the pain or infection accompanying diagnoses.