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Podiatry Coding Tips to Improve Your Bottom Line April 16, 2021

Doctor looking at Podiatry Coding

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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