>>Maybe we have some esoteric thing.. beats me, but the MD makes his living, as did the one in Long Island, by clipping toenails for Medicare recipients every 3 months and calling it "tissue removal."

Here's what CMS says about it: see Point 2 in the "Exclusions" section for toenail clipping that is not covered except in defined circumstances. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicarePodiatryServicesSE_FactSheet.pdf

The classical justification is diabetes with LOPS as per this National Coverage Determination: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=171

If there are physicians claiming Medicare funds by attributing toenail clipping to "tissue removal," then those physicians are behaving like a businessperson who fills their tax return with false deductions. I say "if" because Medicare bills aren't just a claim for service, you have to supply "medical necessity" diagnosis codes to justify the claim and the CPT procedure codes are specific enough to show the tissue removal is from a particular toe. Care of corns and footcare in general is excluded so even for tissue removal the physician must have asserted that you have some other condition justifying podiatric service. If physicians do this systematically as you assert, it results in a "blip" or unusual concentration of service or diagnosis codes that Medicare is adept at spotting for the purpose of Audit. The penalties for overclaiming are severe, including jail time. The scenario you describe is so brazen that I'd expect the auditors to be in like Flynn and for the physician to be trying on their new orange overalls.