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:


  • 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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Best Practices and Tips for Podiatry Billing February 22, 2021

podiatry billing tips

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!

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