The field of podiatry is related to the diagnosis and treatment (medical and surgical) of the diseases and injuries of foot, ankle and lower extremities. Ultimately, a podiatrist makes you stand on your feet; consequently they are entitled to capture every bit of their productivity and support provided to patients. For this, specific rules and guidelines need to be followed in podiatry medical billing which can increase reimbursements and avoid time delays.
The first and foremost requirement set by CMS is that the only covered podiatry services are those which are considered medically necessary and require reasonable foot care. Also, for warts treatment, insurance is covered if they are located on any other part of the body and not be considered as a specialized pediatric service. For routine care, it must be mandatory or act as a supplemental benefit. Also reimbursed by Medicare is care of the patient’s foot with chronic diseases, wound care treatment, and Hyperbaric oxygen therapy for hypoxic wounds and diabetic wounds of the lower extremities (mb-guide.org). Insurance is also provided by Medicare for preliminary diagnostic services if they were performed due to a grievance or a symptom shown by the patient.
Exceptions in podiatry billing which are paid by insurance providers are:
In cases where subluxation or dislocation of the ankle joint and its care, therapeutic shoes for diabetics, orthotic shoes required for a leg brace, Arteriosclerosis obliterans, Buerger’s disease, peripheral neuropathies involving the feet or special shoes/inserts for diabetics.
In podiatry billing, routine foot care faces outright denials for services such as initial care, diagnosis of the presence of metabolic, neurologic or peripheral vascular disease, flat foot, mycotic nails, and foot issues due to diabetes mellitus, chronic thrombophlebitis, or peripheral neuropathies. In cases of diabetes mellitus, Chronic thrombophlebitis and other peripheral neuropathies related to malnutrition and vitamin deficiency, drugs, toxins, multiple sclerosis, carcinoma and uremia, these are covered only if the patient is being checked under a doctor of medicine or osteopathy who documents the situation.
Treatments of a flat foot along with care, correction or usage of supporting devices for such a condition are not covered by Medicare. Also, it does not cover therapeutic shoes and other supportive devices used for feet. Routine foot care which includes removal of corns and calluses, nail trimming and debriding, cleaning of feet etc. are not covered by Medicare.
Other podiatry billing guidelines are:
While submitting the claim for the first time, the document must comprise the name of the physician who diagnosed the problematical condition, including the severity of the diagnosis. This document must hold the date on which the visit was made by the patient. If the podiatric service is being performed by a non-podiatrist, and is a routine foot care, they will not be reimbursed. i.e. the nature of service is more essential that the physician performing the task. Some services are identified as incident to services i.e. even if the incidental service is not included, services provided to the integral part of that covered procedure will be compensated.
Usage of podiatry billing software can increase reimbursements for podiatrists as the software is automatically updated with latest rules, codes and guidelines to be used by the podiatry billing and coding team.
For appropriate podiatry coding, it is advisable to know the difference in ‘corn’ and ‘callus.’ If it is dealing with different locations, but the same physician (the patient has been seen by this physician in the last three years), the patient is considered an established patient and not new; different physicians (different specialties) implies new patients. It is to be kept in mind that consult codes are not different for new and established patients. Also, one needs to watch for over-coding.
Usually in podiatry, the medical necessity determines the MDM level and the apt E/M service level. According to section 30.6.7 of the Medicare Claims Processing Manual, “An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient.”
The expert team at Medical Billers and Coders provides tailor-made services to physicians. They are aware of the CPT and HCPCS codes, podiatry modifiers and follow compliances, which aid in lesser denials/rejections and augment reimbursements. The team also provides services for forensic podiatry services, sports medicine, reconstructive rear-foot and ankle surgery, pediatric services and diabetic limb salvage and wound care services.