Podiatry coding and billing are challenging because treatments and procedures involving the foot are unique due to medical necessity requirements and restrictions on certain conditions. To get the most out of your reimbursement, you need to have complete documentation. Also, you need to know insurance coverage and complicated codes. Here are five tips for boosting your reimbursement:
Appeal for denials
When the insurer has decided not to cover a claim, a claim may be denied, and it will not be paid. Check the explanation of benefits (EOB) sent by the health insurance company to know the exact reason for denial before appealing. Address the reason for denial when appealing. Check the carrier’s written policy for exceptions, as well. Following the submission of the appeal, the practice staff can either contact the insurance provider to confirm receipt of the appeal, or check the submission online and follow up within 30 days. Following appeal submission, the practice staff can either contact the insurance provider to confirm receipt of the appeal or check it online and follow up in 30 days.
Verify insurance properly
The method of reviewing the patient’s plan with the insurance provider and confirming the eligibility of his or her insurance claims is known as health insurance verification. In podiatry billing, the first step is to verify insurance coverage. Until beginning care, check and validate the patient’s insurance eligibility and benefits to minimize denials and improve cash flow. Patients must be aware of their payment obligations at the time of appointment scheduling, which aids in their decision-making and helps the practice prevent last-minute cancellations due to ineligibility.
Verify all information, including the patient’s name, date of birth, address, insurance ID number, deductible, and insurance phone number, in addition to confirming the patient’s insurance coverage.
3. Claims Involving Complicating Conditions
On the first submission of a claim for podiatry claims involving complicated conditions, coders must document the name of the physician who diagnosed the condition and the approximate date the beneficiary was last seen by the indicated physician (when active care is required). Carefully record the diagnosis and the severity of the diagnosis.
4. Accurate codes matter
Coding in the field of podiatry is quite complex. In medical claims, you need to use the most suitable code to record podiatry procedures. It is vital to use the correct CPT, HCPCS, and ICD-10 codes for all medical statements, whether you link it to pressure ulcers, illnesses, fractures, active wound care management, or debridement.
Use the following medical codes in billing for foot care:
- 11055 – Skin lesion Trimming
- 11056 – Skin lesion Trimming (two to four)
- 11057 – Skin lesion Trimming (more than four)
- 11719 – Non-dystrophic nails trim
- 11720 – Nail Debridement (till 5)
- 11721 – Debridement (more than six)
- 11730 – Partial or complete nail plate avulsion
- 11732 – Additional partial or complete nail plate avulsion
- G0127 – Dystrophic nails trimming, any number
- G0245 – Initial physician assessment and treatment of a diabetic patient with diabetic sensory neuropathy resulting in lops, which may include: (1) a lops diagnosis, (2) a patient history, and (3) a physical examination that includes at least the following components: (a) visual examination of the forefoot, hindfoot, and toe web spaces; (b) assessment of a protective sensation; (c) assessment of foot structure and biomechanics; (d) assessment of vascular status and skin integrity; and (e) assessment and footwear recommendation; and (4) patient education
- B35.3 – Tineapedis
- B07.0 – Plantar wart
- E11.621 – Type 2 diabetes mellitus with foot ulcer
- E13.4 – Other specified diabetes mellitus with neurological complications
- S83.9 – Sprain of unspecified site of knee
- S93.3 – Subluxation and dislocation of the foot
Coders must keep up with changing coding standards and guidelines, as any mistakes in codes submitted will result in claim rejection or payment delays.
5. Choose the right modifier.
It would be necessary to apply appropriate modifiers to a claim form that contains such procedure codes to distinguish between the codes that were paid on the date of operation. Class A (Q7), Class B (Q8), and Class C (Q9) results are denoted by “Q” Modifiers (Q7, Q8, and Q9) in podiatry.
The following are some of the most common modifiers used in podiatry billing:
- GX Notice of liability issued, voluntary under payer policy
- GZ Item or service expected to be denied as not reasonable and necessary
- Q7 One Class A finding
- Q8 Two Class B findings
- Q9 One class B and 2 class C findings
You can modify the procedure codes 11055, 11056, 11057, 11719, 11720, 11721, and G0127 with the “Q” modifier. When submitting claims with the Q7, Q8, or Q9 modifiers, indicate the findings related to the patient’s condition.
- Class A Findings: Non-traumatic amputation of the foot or integral skeletal portion thereof.
- Class B Findings: Absent posterior tibial pulse, advanced trophic changes, and absent dorsalis pedis pulse.
- Class C Findings: Claudication, temperature changes, edema, paresthesias, and burning.
The use of correct modifiers often aids in the collections, reducing errors, and avoiding revenue decline. When hiring an outsourced podiatry billing company to handle such paperwork, make sure they specialize in podiatry and experts in the medical billing industry.
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People who have been dealing with medical coding for a long time know the frustrations of its complexity. A simple coding error can lead to increased claim rejection rates and decreased reimbursement rates. Doctors in Podiatric Medicine are not strangers to the intricacies of coding. They have to strictly use the appropriate modifiers, protocol codes, and patient diagnosis codes. Here are several tips that can help you avoid podiatry coding mistakes:
Review podiatry coding updates
The healthcare industry has undergone significant transformation in recent years, and podiatry is no exemption. Every year, there are coding improvements for all specialties, and coders must be aware of these changes to receive adequate compensation from payers. Furthermore, it has been noted that the podiatry coding standards have changed, and practices that are ignorant of these changes incur losses.
The Medicare Physician Fee Schedule requires billing and coding workers to be mindful of various fees and regulatory updates. Knowing these rules will help practices minimize the amount of paperwork they have to deal with when it comes to Medicare billing.
Use the correct modifiers
Correct modifiers allow for accurate payment of all podiatry procedures, including bunionectomy procedures. We highly recommend checking Correct Coding Initiative (CCI) edits, which can be found on the CMS website or in podiatry-related websites like the American Podiatric Medical Association (APMA) Coding Information Center.
When coding Evaluation and Management (E/M) modifiers, coders are often confused. The -24, -25 and -57 modifiers are three basic assessment and management (E/M) modifiers. For E/M programs, these modifiers must be used. Assert declination would occur if these modifiers are used for other utilities.
Specific E/M codes are paid rather than being combined for a single payment. If the E/M service is “important and separately identifiable” from the treatment a podiatrist is doing on the same day, use modifier 25. If medical attention was not needed, do not use this modifier.
Be careful in “Unbundling”
Unbundling, also known as fragmentation. refers to reducing the billing and base process of each component that can result in a higher payment than billing the entire comprehensive code. However, take note that unbundling for the sake of obtaining a higher payment can be considered fraudulent billing.
Use the appropriate modifier to unbundle services properly
There are many legally unbundled cases. When two codes are performed at two different anatomical locations, they can be bundled together but are paid separately.
For example, billing for an arthroplasty code and a bunion code. If you’re not using any modifiers, group them. When performing these procedures on a lesser digit, using the right modifier would cause a bunion procedure as well as an arthroplasty procedure to be properly compensated. Another example is paying for several “single” procedures where there is a code for the same treatment that is classified as “multiple.”
Double-check for any downcoding
Another common blunder is downcoding. Upcoding entails paying for a higher quality of operation or different services than would normally be necessary. On the other hand, downcoding doesn’t have any useful purpose.
The idea is that if you obtain and bill a lower-level code (usually an E/M service), you’ll “go under the radar,” lowering your chances of being audited by insurance agencies. An insurance provider may be worried that, although you are costing the insurance company less money, your billing can still be considered fraudulent.
You could be cheating yourself out of legal money if you downcode. Changes in relative value units (RVUs), sequestration, and fines for not engaging in the Merit-Based Incentive Payment System (MIPS)/Medicare Access and CHIP Reauthorization Act (MACRA) scheme all appear to be eroding the reimbursements. Downcoding means you’re losing more money. Get paid for what you do and keep a copy of the chart note on hand to support your billing.
Tap Into Our Expertise on Podiatry Coding
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times with podiatry coding.
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Podiatry billing is said to be more challenging than other specialties. It involves different procedures making it more intricate as it requires meticulous coding related to where, when, and what procedures were made. It needs the most competent billers and coders who are up-to-date with the latest revisions of the requirements for Podiatry billing, code-specific regulations, and compliance standards. Even the smallest mistake or error could lead to denials of claims and loss of revenue. Here are the best practices and tips for Podiatry billing straight from our medical billing and coding experts:
Podiatry Billing Tips and Practices
1. Update your Billing System and Software
It is important to utilize the correct billing system that suits your practice to keep up with today’s dynamic and rapidly changing market. It will help improve the efficiency, quality, and turnaround time by investing and implementing an acceptable EMR, billing system, and software.
2. Include Comorbidities in Coding
Providers documents relevant conditions called comorbidities. Coding them will help you receive higher reimbursements. It also notifies the insurer about the additional cost.
3. Code Diagnosis Instead of Symptoms
Unless there are client-specific guidelines to code the symptoms, it is essential to analyze the medical reports and code the confirmed diagnosis instead of reporting symptoms. Similarly, the coding of additional disease-related symptoms should be avoided unless indicated.
4. Stay Current with the Billing and Coding Changes
The first step towards effective Podiatry billing is to guarantee that your team is up-to-date with the latest changes to the billing and coding guidelines. The guidelines for Podiatry-related procedures and medical billing are often updated and modified due to their complexity. It is essential that your Podiatry billing team stays current.
5. Audit your Medical billing and Coding Regularly
Podiatry coding and billing mistakes can appear unavoidable due to their complex nature. Having regular audits can help monitor the percentage of errors while at the same time helping to analyze their causes. It ensures consistent steps are taken to minimize recurring errors. The audit also helps you to consider the staff and provide them with extra preparation or retraining. ‘
6. Reevaluate Your Documentation Process
Podiatry billing can be challenging. Any documentation gap can result in missed billable codes, which would potentially hamper the practice revenue. Accurate and full documentation of the exact process is necessary to minimize the rejection of claims. Processing claims with insufficient and erroneous paperwork can be time-consuming and lead to delays in services.
7. Use Combo Codes Appropriately
Podiatry coders must be careful to follow different coding guidelines, such as “Code also,” “Use additional codes,” “Code first,” etc. When necessary, it is important to use combo codes to prevent claims that are rejected, delayed, and denied. However, lacking combo codes implicitly means missing the bill.
8. Outsource your Billing and Coding
You can always partner with a trusted name in medical billing and coding like us at 5 Star Billing Services. We focus solely on medical billing and coding so you can focus more on your clinical services. It will help reduce your turnaround time, overhead cost, and hiring and staffing. Our staff is regularly trained to increase your productivity and quality service.
Tap Into Our Expertise
At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.
Schedule a consultation with our experts today!
For the most part, medical billing companies are designed to offer a generalized service to all types of medical practices. Not distinguishing between the various different medical fields, these companies offer a broad “one size fits all” kind of approach when it comes to the billing services they provide.
This approach, though beneficial to them, as they can service more clients in this way, does not necessarily fully support your podiatry practice.
As a specialist yourself, you will appreciate that your practice has specific billing demands that require the services of a billing company that can understand your needs. It makes sense therefore to choose a podiatry billing company as they will have a thorough understanding of your chosen medical field.
In choosing a podiatry billing company to assist you, you will be teaming up with a company that understands exactly what kinds of services you are offering, know what prescriptions and medical products you are dispensing, and will be able to offer you the best billing strategy.
Podiatry billing companies work only with podiatrists and they already know what you are talking about, there is no need to explain what it is what you are billing for. In this way, they are able to focus their attention on getting your clients to settle their bills and offer greater customer service to your patients.
This will allow you the freedom to focus more on your practice and patients, knowing that you are outsourcing to people who understand and appreciate your medical practice as well as you do.