Financially, the entire healthcare industry is tied to insurance providers that impose their billing rules and requirements. All healthcare providers, including podiatry centers, must adhere to all the ever-changing regulations, in addition to those set forth by the government. This creates billing and medical coding challenges.
The medical necessity and restrictions of foot conditions make billing and coding for podiatry even more complicated. To receive the best reimbursements, podiatrists should not have to deal with all of these details.
Continue reading to find out
about podiatry billing, coding and the factors that affect podiatry reimbursements. Learn about the difference between a procedural service and what it is and why podiatrists should outsource medical billing. Also, how to find a great external medical billing provider.
Podiatry Medical Billing And Coding
What is Podiatry Billing?
Podiatry focuses on foot problems, injuries, or abnormalities. Podiatric medicine deals with the diagnosis, treatment, and surgery of foot, ankle, or lower-limb conditions. This expertise includes therapeutic, surgical, and mechanical foot therapies.
These services are not covered by Medicare because they are routine.
Cut or remove calluses and corns
In ambulatory and bedridden patients, foot washing and soaks are used to maintain the skin tone. Skin creams can also be used to maintain skin tone.
Coding and billing can be difficult in podiatry. This includes the verification of a treatment’s medical necessity and the finer points of coding. The elderly are also treated in podiatry clinics. Medicare supports extra billing and coding. Coding and billing in podiatry require the use of modifiers and knowledge about inclusive procedure coding.
- A podiatrist can either hire a staff of coders in-house or contract a third-party billing service. Medical billing providers must be able to monitor, document, and resolve unpaid claims.
- Collections can be improved by 25% with established best practices and experienced personnel capable of coding accurate podiatry. Rejections can also decrease by 23% when there are less rejections.
What are the Factors that Affect Podiatry Reimbursements
For many reasons, insurance providers may deny claims for podiatric care. A payer may have stopped paying for certain services, or granted the maximum benefit for podiatric care in the claim.
These are the factors that ensure podiatric services receive optimal reimbursements:
Prior approval is required. Authorization rejections are common in podiatry clinics. They will need to obtain authorization from their insurance provider prior to submitting their claim. Once they have been approved by the insurance provider, they are allowed to submit the claim and get the authorization number.
Medical necessity. Coders should be proficient in the use of Current Procedural Terminology codes (CPT). They make sure that both the local coverage determinations and the national coverage determinations are valid. A medical claim must be supported by medical necessity. The documentation that is coding should support the medical necessity of services rendered and billed by a podiatry clinic.
Accuracy in coding is essential. Accuracy in medical coding is crucial for successful claim submission. Additional procedure codes can be individually billed by the healthcare provider according to the payer’s standards.
Why should a podiatrist outsource medical billing services?
Outsourcing can improve patient care and increase employee productivity. The job of a podiatrist is to diagnose and treat patients with problems with their feet or ankles. Every day, podiatrists have to deal with billing and coding.
Because of the specific medical requirements and restrictions regarding foot conditions, external providers are better equipped to handle podiatry medical billing and coding. Also, podiatrists shouldn’t waste time understanding which services are covered by which insurance companies, using the correct codes, and submitting clear documentation.
These tasks are essential for optimal reimbursements. Professional coders and billers can do a better job for a fraction of what it costs, while podiatrists can concentrate on their patients.
A podiatry clinic that outsources its medical billing or coding can receive comprehensive performance reports from an external team. This transparency allows for transparent operations. This is vital for the success and sustainability of a podiatry clinic. External medical billing companies may be able to provide insight into billing operations.
All-inclusive procedures Most insurance providers will deny a claim if the procedures are inclusive. To avoid inclusive rejections, healthcare providers should not bill CPT codes G0127, 11721, and 11721 together. The biller may appeal if an insurance company declines to pay a claim, even if the modifier is necessary.
Service recurrence. Routine foot care is medically necessary once every 60 days. Payers view frequent services as unnecessary and incongruous, so they reject them within 60 days. A biller may appeal by providing medical documentation that proves the need for the service.
What are the Q Modifiers in Podiatry?
Insurance companies are interested in understanding why foot care is done by doctors. Modifiers Q7 (one class A finding), Q8 (2 class B findings), Q9 (1 class B, 2 class C findings), and Q9 (1 class B, 1, and 2 class C findings) can help them. In order to indicate the patient’s condition, Q modifiers are used by billers to submit claims.
Class A – Non-traumatic amputations of the foot or an integral part of the skeletal system
Class B – Absent dorsalis and posterior tibial pulses, and at least three advanced trophic changes (nail thickness, rubor, redness, absence or decrease in hair growth, skin texture, thinness, or shiny skin texture, skin discoloration)
Class C – Temperature changes (e.g. cold feet), swelling of a body part, edema (swelling), claudication.
What is a Distinct Procedural Service?
Modifier 59 (distinct procedure service) means that a procedure performed by the same practitioner on the same day is different from other procedures billed on the exact same date. When multiple services are coded together, mistakes could occur.
Modifier 59 can be used by coders in the following situations:
- Different sessions at the same time
- An anatomically different site or organ system
- Separate incisions or excisions
- A different lesion
- A separate injury
How do you identify a good external medical biller?
For many reasons, billing and coding in podiatry are difficult. Each insurance company sets its own standards to determine if surgery is necessary and reimbursable in a particular situation. As foot and ankle problems become more common with age, Medicare will now cover a greater number of patients. This adds another code and restriction to the mix.
For medical offices and facilities, outsourcing is becoming more common. Outsourcing is possible for individual medical billers who work from home to service thousands of patients.
Medical billing can be complex. It requires extensive experience and a high level of competence to understand all aspects of billing. Medical billing becomes even more difficult when you consider a specialization such as podiatry.
The staff of a medical billing company must be able to understand the regulations and procedures followed by insurance companies in order to assess podiatry claims. Due to rising costs, podiatrists need to ensure that there is no money left over because their external billing provider does not have the expertise in the field. For outsourcing your medical billing services with Medcare MSO, visit here for a medical billing solution.
Coding and billing businesses in podiatry need to recognize that at-home billers are often performing the tasks they claim to be proficient in. Remote employees don’t operate in a controlled and monitored environment, which can lead to high levels of risk.
The bottom line
Podiatrists are medical professionals who focus on foot and ankle problems. Podiatrists are limited in their ability to treat foot conditions due to strict medical requirements. For optimal reimbursements, these healthcare professionals must be aware of what is covered and use the appropriate codes. They don’t have to do all of these things if they contract podiatry billing or coding with an outside provider.
Podiatry billing and coding firms can manage all aspects of claims processing–including examining claims to ensure appropriate coding–validating benefits eligibility, sending out claims, and tracking all accounts receivable.
Professional coders and billers must keep current with the documentation they provide. An external podiatry billing agency should have a proven track record and specialize in podiatry billing. This will ensure that you get the best possible results.
