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.
1. 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.
Routine 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)
- G0127 – Dystrophic nails trimming, any number
DME:
- A5500, A5512, A5513 – Diabetic Shoes and Inserts
- L3000, L3020, L3030 – Orthotics L4397- AFO
Other CPT Types:
- Casting/Strapping
- Incision & Drain Removal
- Biopsy
- Soft Tissue
- Nails
- Skin Substitute
- Ultrasound
- X- Ray
- Injection
- Physical Therapy
- Injection
- Surgery Minor and Major
ICD-10:
- B35.1- Tinea unguium
- L60.0- Ingrowing nail
- L60.1- Onycholysis
- L60.2- Onycholysis
- L60.3- Nail dystrophy
- L84- Corns and callosities
- I73.89- Peripheral vascular diseases
- E Series – Diabetes Code
Coders must keep up with changing coding standards and guidelines, as any mistakes in codes submitted will result in claim rejection or payment delays.
2. 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- Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered
- GY- Report this modifier only to used to obtain a denial on a non-covered service
- KX- Requirements specified in the medical policy have been met
- 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
- TA- T9- Toe Modifier
- LT & RT- Side Modifier
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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