Open letter to Primary Care Doctors who tell elderly patients Medicare should cover the cutting their toenail(This is not true, most of the time)

Though I am trained in foot an ankle surgery, I must admit my favorite patients are my elderly patients that just come in to the office for routine foot care.  I see them every couple of months, we talk about their grandchildren, my kids and life in general.  We establish a fantastic long term relationship that is full of amazing conversation, while performing a task they are unable to perform themselves.

But when we see many of these patients as a first encounter they are convinced that this is a covered service by Medicare.  Some people believe this because they have seen a podiatrist for years before they moved to our area and the doctor has been billing this illegally or they have seen their primary care physician and they say, "Medicare covers cutting of the toenails." This simply is not true!

It is true that if you are diabetic, meet certain class findings, and have seen your primary care physician, who is actively treating your diabetes, in the last 6 months, then yes Medicare will cover such a service. But as far as someone who just happens to be elderly with long toenails, no dice! Below is an excerpt from the medicare.gov regarding podiatry services that are covered:

"Medicare Part B (Medical Insurance) covers podiatrist services for medically necessary treatment of foot injuries or diseases (like hammer toes, bunion deformities, and heel spurs). Part B generally doesn't cover routine foot care (like the cutting or removal of corns and calluses, the trimming, cutting, and clipping of nails, or hygienic or other preventive maintenance, including cleaning and soaking the feet)."

This becomes a very big source of contention in our office on a daily basis, over exhausting our resources of our office staff having to explain to patients why this is not covered.  But many elderly people can not perform this service themselves due to: not being able to reach their feet, bad back, bad hip or even they are just too thick for them to cut.  All of these are great reasons for an elderly person to be seen by a podiatrist for this service but insurance will not cover it and the patient has to be prepared for this out of pocket expense. These patient's are given a Medicare Advance Beneficiary Notice that explains that it is not a covered service. 

Encouraging an older person to go to a nail salon can be irresponsible advice from a doctor and a big problem exposing the patient to many community acquired skin and nail infections.  There are only 2 states that require that nail salons autoclave their instruments: Iowa and Texas.  So sending an elderly person into this environment is really not a great idea.

In our office we perform the highest level of care for these patients.  They are seen by the podiatrist, not a tech or medical assistant. The podiatrist will evaluate and treat the patient professionally debriding(cutting) the the toenails and the calluses if necessary.  The patient will leave with peace of mind knowing that they are getting the best possible care and service for their feet.

What we charge for these services are below:

Trimming of toenails	$60
Trimming of calluses	$60
Trimming of toenails and calluses	$75

Sometimes these services can take up to 45 minutes when someone has very thick toenails and many calluses.  We do not rush through this exam and service because our ultimate goal is to give the patient the best possible outcome.  We see many patients for this type of non covered routine foot care and try to perform this in a way that we can space out the visits so they may only need to visit us 3 to 4 times a year.  

Most podiatry offices offer this type of service and prices range from $50-$75.  The expense may seem steep. but by having a nail care patient in the treatment room the podiatrist is possibly missing much higher revenue of a new patient or even reimbursement for a follow up for an established patient.  Like all other doctor offices we have multiple staff: medical assistants, billing company, insurance specialist, and receptionist. These people all have to be paid for their hard work.  So it really is impossible for us to perform this service for less. If the doctor is performing the service themselves this service is very well worth it for the patient and in the patient's best interest.

If you would like to learn more about our office see our website: http://centeranklefootcare.com/