Podiatry as a specialty is quite different and coding professionals need to be aware of the complexities in this specialty to reduce denial of claims. Medicare and commercial payors insist on medical necessity for foot care and thus, coding in podiatry coding specialty and revenue cycle management (RCM) is an area where confusion reigns. Most of the payors will reimburse if there is a foot condition but not for preventive care. Hence podiatry coding procedures need to be dealt with carefully.
Podiatry coding mistakes
Here are the areas where mistakes occur, impacting your cash flow.
1) Incorrect codes
It should be ensured that each CPT code is correctly linked with the ICD 10 code. Based on the patient’s condition, several codes may be required. While regular training for billers and coders in industry changes goes a long way in developing their expertise, foot care training is almost a necessity for podiatry coders. Such education will reduce the likelihood of errors. Also, checking with payors regarding the correct use of codes will bring down errors.
2) Incorrect modifiers
Incorrect use of modifiers can cause claim denials as much as not using a modifier. So, when using modifiers, coders should clearly understand what the modifier means.
In Podiatry, there are three evaluation and management (E/M) modifiers, namely 24, 25 and 57 modifiers. These are to be used only with E/M services. Hence, when used for any other service such as a diagnostic study or procedure, the payor will deny the claim.
To ensure the correctness of codes, coders can check out the Correct Coding Initiative (CCI) edits, which are on the CMS website or the website of the American Podiatric Medical Association (APMA) Coding Resource Center and similar podiatry specialist agencies.
3) Improper unbundling of services
A fundamental doctrine in billing is that if there is a code that already includes the various components of a procedure into one standard code, then that is the code to use. On the other hand, unbundling implies that a base procedure is improperly broken down into its constituent parts to obtain higher reimbursement. It can be considered fraudulent by payors.
However, there is also legitimate unbundling. Such unbundling may be required for the kind of procedure being carried out by the physician. The expertise of the coder will decide how to unbundle services properly.
4) Down-coding mistakes
Down-coding, as opposed to up-coding, is the practice of coding for a lower level of service than what was carried out. This will only result in losing money. Also, consistent down-coding may attract audit as it will show up in the payor’s system.
So code for what service has been done, backed up by necessary documentation.
5) Physical therapy, documentation
It is prudent to check with payors whether there is coverage for the treatment needed by the patient. Therefore, the details of diagnosis, treatment modalities (which can be done only by the provider), frequency, and treatment duration should be precise.
In the case of X-rays, the number of views should be only what is medically necessary.
For cases of surgery, check whether prior authorization is needed. Check with payors for the codes to be used.
Bristol Healthcare can help with your coding
Podiatry billing and coding can be complex—also, the codes for podiatry change more frequently than for other specialties. At Bristol Healthcare Services, our billers and coders have the expertise to deal with podiatry coding correctly. Our coders are trained in all aspects of coding. We will ensure that the mistakes commonly made will not happen to you. Your claims will be reimbursed quickly.
Bristol Healthcare Services believes in educating its staff regularly. In a continually evolving industry, it is imperative to remain on top of all the changes being made. We have invested in people and technology so that our clients may always get the best services from us. It is this commitment that has made us one of the best billing and coding companies in the country.
Partner with us and let us grow together!