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Podiatry Billing Tips to Boost Reimbursement

April 30, 2021

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:

CPT:

  • 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

HCPCS:

  • 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

ICD-10:

  • 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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