Podiatry is a medical specialty devoted to studying complications related to the foot. Which involves diagnosis, medication, and surgical treatment.
Services offered by the podiatry specialist are paid by the insurance companies or in case if some services are excluded from the insurance coverage then the patient is liable to pay for them.
Podiatry medical billing proves to be complicated as it essentially treats the elderly, which is a large set population covered by Medicare. Which demands additional efforts in the medical billing and coding process.
As there is a higher possibility of a coding error, which results in claims denials and loss of revenues. And an additional effort to make your coding compliant with the recent guidelines by Medicare increased the workload of podiatry practices.
Recently a coding guideline was issued for Podiatry practices. For efficient billing activity, you must be compliant with these guidelines.
Coding Guidelines For Podiatry Medical Billing
Proper coding is imperative for clean claim submission. Codes are applied to describe the treatment and diagnosis provided to the patient to prevent claim denial and increase revenues.
There are varieties of codes, some are considered for one operative procedure, while some are applied in an obscure form of treatment.
Based on the insurer company requirement multiple codes are set with each other. A thorough evaluation of all these codes is important for your practice. In case of any error, you may face claim denials which will eventually increase your account receivable. Moreover, coding experts should keep themselves up to date for the new policy regulation by Medicare.
For some services modifiers are required, they are used to give additional information to the payers about the treatment and services under certain circumstances.
The policy guideline for Podiatry practices under healthcare Medicare are given below:
There are multiple services that are not covered by Medicare including general routine foot care, except under the following conditions:
- When it is mandatory with other treatment procedures.
- During the diagnosis and treatment of ulcer wounds
- Trimming nail following a fracture.
- Subluxation of the foot, an exception in the case of ankle dislocation.
- Flat foot and some devices except therapeutic and orthotic shoes.
- Metabolic, neurologic, and peripheral vascular disease.
- Treatment of warts and Mycotic nails.
- The treatment of mycotic nails can only be covered when there is clinical evidence of mycosis in toenails and the patient is ambulatory. In the case of non-ambulatory, the extent of secondary infection should be taken into consideration.
Under the new policy guideline, the covered services include a diagnosis involving hyperkeratotic lesions,non-dystrophic nails, debridement of nails, and dystrophic nails.
And foot exams for people with diabetic sensory neuropathy.
There are many other chronic diseases that are covered under new policy guidelines
List of Codes
Below are some of the procedural or diagnosis codes, which are given for reference purposes only.
- CPT Code 11055 is applied for cutting benign hyperkeratotic lesions.
- CPT Code 11719 is applied for trimming non-dystrophic nails.
- CPT Code 11720 is applied for the debridement of nails.
- CPT Code G0127 is applied for trimming of dystrophic nails
- CPT Code G0245 is applied for Primary administration of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation.
- CPT Code G0247 is applied for Routine foot care by a practitioner of a diabetic patient with diabetic sensory neuropathy following a loss of protective sensation.
Modifiers are used as additional information to the players in coding. These modifiers are utilized with the codes. The modifiers Q7 for 1 class A findings, Q8 for Two class B findings, Q9 for One class B, and 2 Class C findings. Below is the description of each modifier:
Q7- One Class A findings
This modifier is specifically used in the case of nontraumatic amputation of the lower extremity (A serious complication of diabetic neuropathy and peripheral vascular disease) or integral skeletal portion.
Q8- Two Class B findings
This modifier is applied in case of the absence of posterior tibial pulse, advanced trophic changes, and absent Dorsalis Pedis artery pulse.
Q9- One Class B & Two class C findings
This modifier is used in edema, paresthesia, burning, temperature fluctuations, and claudication.
For more information, you can see the updated document of Podiatry Policy guidelines.