The field of podiatry is related to the diagnosis and treatment (medical and surgical) of diseases and injuries of the 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 the 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 medical 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.
Non-coverage:
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. is 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 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 an integral part of that covered procedure will be compensated.
Solutions:
Usage of podiatry billing software can increase reimbursements for podiatrists as the software is automatically updated with the 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 (MBC) provides tailor-made services to physicians. They are aware of the CPT and HCPCS codes, and 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. For podiatry medical billing and coding assistance, email us at: info@medicalbillersandcoders.com or call us at: 888-357-3226.
FAQs on Podiatry Medical Billing
1. What podiatry services are covered by Medicare?
Medicare covers podiatry services that are medically necessary, such as foot care related to chronic diseases, wound care, and Hyperbaric oxygen therapy for diabetic or hypoxic wounds. Preliminary diagnostic services are also covered if performed due to a patient’s grievance or symptoms.
2. What podiatry services are not covered by Medicare?
Medicare does not cover routine foot care like corn and callus removal, nail trimming, and debriding. Treatments for flat feet and routine care, such as cleaning of the feet, are also excluded. Therapeutic shoes and other supportive devices are generally not covered unless required for specific medical conditions.
3. Are podiatry services for diabetes patients covered?
Yes, podiatry services for patients with diabetes are covered, especially in cases of peripheral neuropathy, diabetic wounds, and the need for therapeutic shoes or orthotic devices. However, these must be documented and performed under the supervision of a medical doctor or osteopath.
4. What documentation is required for podiatry claims?
For podiatry claims, the documentation must include the physician’s name who diagnosed the condition, the severity of the diagnosis, and the date of the patient’s visit. Proper documentation is crucial for successful reimbursement and must follow Medicare’s guidelines, especially for initial claims.
5. How can podiatry billing software improve reimbursements?
Podiatry billing software can improve reimbursements by ensuring that billing teams use up-to-date codes, rules, and guidelines. It helps prevent overcoding, reduces the chances of claim denials, and ensures compliance with current regulations, leading to higher reimbursements.
