A person who has dealt with medical coding since long can realize, medical coding is a complex, sometimes illogical, and dynamic. Frustration and medical coding go hand in hand that could lead to declination in revenue performance. A small mistake in medical coding can result in claim rejections and decreased rate of reimbursement. Podiatry coding includes the usage of the proper modifiers, procedure codes, and patient diagnoses codes. Doctors of Podiatric Medicine (DPM) generally experience delayed claim submission process.
However, errorless procedures, personalized coding, and other challenges make podiatry billing more complex. With all-inclusive and particular codes, podiatry coding is a specialized process. In addition to this, podiatry practices have to keep an update regarding continuous changes in the coding standards or they could come across certain revenue losses. This article comprises of not only various podiatry coding aspects but also focus on common podiatry mistakes.
Let us jump on to several tips for avoiding podiatry coding mistakes in 2020:
Select proper ICD-10 and CPT codes
Procedure coding as well as a diagnosis for podiatry needs coders to gone through certain training of foot care. Moreover, they also needed to document and prove medical necessity as well as national and local coverage determination. Podiatry claims should be submitted with the accurate CPT codes, which are properly adjusted with the appropriate ICD-10 codes. If patient possess more than one condition, then multiple diagnosis codes may require.
Coders have to keep in mind the guidelines of an insurer regarding which codes to incorporate. By doing so, coders will have thorough knowledge not only about the diagnosis but also procedure codes in the podiatry.
Practices have to ensure to enforce changing coding guidelines. ICD-11 is the upcoming milestone that will change the healthcare industry. This code set was accepted by the World Health Organization (WHO) on 25th May 2019 and anticipated to go into effect on 1st January 2022. Furthermore, ICD-11 is projected to transform the method; conditions are segregated and coded in the clinical setting.
Not reviewing podiatry coding updates
It has been witnessed that the healthcare industry has transformed over the past few years and podiatry is no exception for this. Every year coding changes are upgraded for every specialty and coders should understand these updates for proper reimbursement from payers. Furthermore, it has been observed that there are a number of changes in the podiatry coding guidelines, if practices are unaware about these guidelines they could suffer losses.
For example, billing and coding staff have to be aware about the Medicare Physician Fee Schedule that contains multiple payments and policy changes. Knowing these guidelines may reduce the excessive paperwork burden on practices when it comes to billing for Medicare.
Utilizing incorrect modifiers
Utilizing correct modifiers will permit all podiatry procedures such as bunionectomy procedure to get accurately paid. Coders are suggested to review the Correct Coding Initiative (CCI) edits, which are on CMS website or in podiatry-based resources like the American Podiatric Medical Association (APMA) Coding Resource Center.
Coders often confused while coding Evaluation and Management (E/M) modifiers. There are three specific evaluation and management (E/M) modifiers such as are -24, -25, and -57. These modifiers must be utilized with E/M services. Using these modifiers with other services will result in claim declination.
E/M codes compensated individually rather than combined for a single payment. Utilization of the modifier 25 is confusing. Ensure to utilize modifier 25 when the E/M service is “significant and separately identifiable” from the procedure a podiatrist is performing on the same day. However, do not utilize this modifier if medical care was not required.
Aim on appropriate services’ unbundling
Unbundling indicates to cutting down the billing and base procedure of each component parts leads to greater payment than billing overall comprehensive code. Nevertheless, unbundling to attain greater reimbursement can be treated as fraudulent billing.
There are services, which are coupled under a single code, which displays that, the podiatrist has performed one service as the result of doing another.
There are particular cases where providers will purposefully manipulate coding for greater payment. Such kind of manipulation is termed as Medicare fraud. Unbundling is also known as fragmentation.
If the coder is unable to understand the correct coding procedure, unbundling could happen. Upgraded quarterly, NCCI is developed to make sure that physicians do not improperly unbundle CPT codes.
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