Routine care versus medical necessity
Nail and callus care for a diabetic patient with neuropathy may be covered. The same service without supporting documentation is usually not. The claim itself looks identical.
We check that the systemic condition and documentation support coverage before submission, and flag the cases that will become patient responsibility so the notice happens up front.
- Routine foot care coverage criteria and documentation
- Procedure coding for nail, lesion, and wound care
- Diabetic supply and shoe billing requirements
- Surgical global periods and post-operative visits
Wound care and the long tail
Diabetic wound care generates recurring visits and, sometimes, balances that outlive the treatment plan. Tracking them as episodes rather than individual claims makes the pattern visible.
We report on wound-care episodes separately, including authorization status and patient balances.