Monday, January 30, 2023

Podiatry Billing Services

Must read

What is Podiatry?

Diagnosing and treating diseases, wounds, and deformities of the human foot are the focus of the medical specialty of podiatry. Diagnosis, medicinal and surgical treatment, and prevention of foot, ankle, and lower extremity ailments are all part of podiatry or podiatric medicine. Treatments for the foot that is mechanical, physical, medical, and surgical are also included in this specialty.

Podiatry billing can be challenging in various ways, from the subtleties of coding to the requirement to establish and support the treatment’s medical necessity. Additionally, since Medicare covers this demographic, podiatrist practices typically treat the elderly, necessitating additional billing and coding efforts. Modifier usage must be exact, and coding for inclusive operations must be understood.

Podiatrists frequently employ internal teams of coders or outside billing organizations that advertise having competence with podiatry billing. Many of these services often need the knowledge to regularly track, record, and resolve outstanding or underpaid claims. As a result, podiatrists are forced to switch to outsourcing their billing and coding requirements to reputable and effective billing businesses with experience in the field. One of the first companies to offer billing and coding services for podiatry is Medical Billing Wholesalers. Identifying and correcting critical billing and coding errors in podiatry can regularly increase collections by over 23% and decrease denials by over 25%.

Using the best billing and coding procedures in podiatry

The payer has terminated coverage for many podiatry claims; the treatments were not covered or had already used the maximum benefit for podiatry services. The companies regularly review the insurance & coverage information because insurance specifics are subject to change. To avoid repeated denials, medical staff also ensures the patient is aware of the insurance treatments the insurer does not cover. They must guarantee HIPAA compliance at every step of the billing and coding process.

Best Podiatry Billing & Coding Practices

Prior Permission.

In podiatry, authorization rejections are typical. To get reimbursements, you must submit the claim along with the authorization number and secure prior approval from the payer.

Provide a referral

Provider codes must be placed after the CPT codes when invoicing for Medicare.

Precise coding.

For a clean claim submission, accurate medical coding is a need. The provider may independently bill for extra procedure codes with other codes following the payer’s policies.

Medical Requirement.

The coding team should be adept at billing and utilizing the appropriate CPTs and diagnosis codes under the standards. The codes must confirm LCD and NCD (National coverage determinations) (Local coverage determinations). Additionally, coding documentation must attest to the medical necessity of the services and treatments. The appeal of unpaid claims will subsequently benefit from solid documentation.

Comprehensive Services.

The majority of claims are rejected because the procedures are inclusive. Billing CPT codes 11719, 11721, and G0127 combined will result in inclusive denials. The CCI (Correct Coding Initiative) modifications should be examined. Should file an appeal with the relevant medical records if the insurance company rejects the claim despite using the correct modifiers.

Service frequency.

Once every 60 days, routine foot care services are deemed medically required. Within 60 days, payers will refuse repeated services because they believe them to be unreasonable and unnecessary. Providers may contest such claims for payment by providing the required medical documentation attesting to the services’ necessity.

Q Modifier use.

The findings about the patient’s condition are disclosed when claims are submitted utilizing Q modifiers. The billing codes for podiatrist services are Q7, Q8, and Q9.

The timely billing and account reimbursement are strongly tied to the financial health of your podiatry practice. One of the most crucial choices you’ll ever make for the financial side of your practice is choosing a reputable podiatry billing provider. Your podiatrist billing business must have the expertise required to manage the challenges posed by Podiatry billing and modifiers. To learn more about the services, references, and other important information pertaining to Podiatry billing services, please visit the business website’s homepage.

Numerous billing service providers have extensive knowledge of working with podiatrist clinics. Billing services can assist podiatrists in enhancing collections, reducing claim denials, and improving their accounts receivable.

This is crucial since podiatrists are dealing with steadily rising prices and cannot afford to lose money.

Understanding the complex regulations and standards insurance companies use to evaluate podiatry claims is crucial for performing billing and coding responsibilities for podiatry practices and ensuring maximum payment for the services rendered. Many billing businesses make this industry knowledge their share of fame, but many fall short. A podiatrist might lose about 10% of their income because medical billing businesses that do not specialize in podiatry billing may not be able to track and pursue underpayments adequately.

Working with podiatry billing services run by qualified, licensed billers will help podiatrists clear of billing and coding-related traps like this.

Benefits of using a podiatry billing service provider

  • Increased revenue and collections
  • reduced stress and accelerated payments
  • Your patient data and financial details are available around-the-clock.
  • Understand where your money is.
  • Integrity throughout the whole revenue cycle
  • complete reporting on finances and practice management
  • The security and comfort that comes from knowing that experts are handling billing and that income and reimbursements will increase

Billing, collections, and practice management for podiatry as a whole

  • Several businesses provide comprehensive billing and collections services for podiatry. 
  • Before continuing, a preliminary analysis of your practice and AR is presented.
  • A good business makes it simple to get started and is committed to bringing its clients paid!
  • Certified Professional Coders from the company will receive the highest compensation for the patient.
  • Dedicated computer hardware and software for podiatrists
  • Service includes patient feedback, comments, and follow-up.
  • Additionally included are complete electronic claims and AR management.

Why Should Your Podiatry Practice Outsource Medical Billing and RCM?

As a podiatrist, you meet patients with various diseases, from traumas and specific skin conditions to chronic illnesses like arthritis and diabetes. Therefore, internal charging can be time-consuming, expensive, and possibly unsafe, especially regarding worker retention.

Whether you are managing a small, single-provider practice or are a member of a larger medical group, outsourcing medical billing and coding for your podiatry firm can help you save time and provide you peace of mind.

How Do I Code Claims for Podiatry?

Before coding, review the patient’s visit and all the supporting documents. They must all be updated and accessible in the patient’s medical file.

There are two kinds of visits to a podiatrist.

  • fresh patient
  • regular foot care (Established patient)

You must carefully study the medical notes associated with each DOS (Date of Service) the provider gave the patient to ensure accurate coding of any claim.

CPT Codes Frequently Used in Podiatry

The procedure codes 11055, 11056, 11057, 11042, 11043, 11045, 11046, 11044, 11047, 11719, 11720, 11721, G0127, and G0247 are used to define and record podiatry services.

Medicare regulations state that at-risk foot treatment is only covered if services are spaced at least 60 days apart.

  • 11720, 11721 – Debridement of fungal (mycotic) nails
  • 11719 – Non-dystrophic nail trimming
  • G0127 – Dystrophic nail trimming
  • 11055, 11056, and 11057 – Calluses and corns 

If there are no “class findings,” nail care needs painful ambulation, which is required in the case of mycosis. Class findings are necessary for all non-mycosis nail care.

Class findings are also necessary for callous care. However, PAIN does not qualify.

What are class findings, and why is podiatry coding dependent upon them?

The criteria designed expressly for podiatry coding are class findings. You would receive verification of which modifier among Q7, Q8, and Q9 must be utilized based on these parameters.

There are three finds of the class:

Class A Results

  • Amputation of the foot or a major skeletal component without trauma

Class B Results

  • Posterior tibial pulse is absent.
  • The dorsal pedal pulse is absent.
  • To satisfy one class B discovery, three of the following advanced tropic alterations must occur:
  • growth of hair
  • pigmentary alterations
  • Skin tone
  • Changes in nails
  • a skin’s surface

Class C Results

  • Claudication
  • Foot temperature variations
  • Edema
  • Paresthesias (abnormal spontaneous sensations in the foot, e.g., tingling) (abnormal spontaneous sensations in the feet, e.g., tingling)
  • Burning

How Do I Choose a Modifier Based on the Results of the Class?

The findings about the patient’s condition are disclosed when claims are submitted utilizing Q modifiers. Podiatric medical services are billed using codes Q7, Q8, and Q9.

Q7 = One Class A discovery

Q8 = Two finds of Class B

Q9 = Two Class C discoveries and one Class B discovery.

Always use modifiers TA to T9 for toenails and F1 to FA for fingernails when performing procedures on either. Never modify left or right fingers or toes with LT or RT. Only procedures involving the left or right foot, not fingers or toes, may use the LT and RT modifiers.

What is meant by LCD?

The acronym “LCD” stands for local coverage determination. The LCD for the specializations that fall under each US state varies.

The importance of LCD is crucial for appropriately billing a claim. Selecting the appropriate diagnosis code with the best matching CPT code is the most critical responsibility for a coder.

The most important tool offered by to determine medical necessity is LCD.

Guidelines for Podiatry Medical Coding: Common Practices

Since many of the services offered by a podiatrist might not be covered by insurance, proving medical necessity and validating coverage are essential for receiving the best possible reimbursement.

CPT code 11721 (Covered Nail Debridement 6 or more) calls for the Q8 modifier for routine check-ups with systemic diseases. For Medicare to pay for something, it must be medically required. However, this is only compensated six times a year.

T1 to T9 modifications are typically added to podiatry codes (Toe modifiers). However, the toe modifiers are not used for CPT codes 97598, 11720, and 11721.

When utilized frequently in podiatry billing, the HCPCS codes J3301 and J1100 (injection treatments) bring in a sizable amount of money for the service providers.

The findings about the patient’s condition are disclosed when claims are submitted utilizing Q modifiers. The billing codes for podiatrist services are Q7, Q8, and Q9.

Append payable modifiers must be applied before class finding Q modifiers, the ten-digit toe modifiers (TA-T9), or the left or right foot modifier if several surgical procedures are carried out (LT, RT)

The CPTs listed below are used with the corresponding descriptions.

  • 76881 Real-time, non-vascular, extremities ultrasound with image documentation
  • 76882 Extremity, non-vascular, limited ultrasound, real-time, and image documentation
  • 93922 single-level, bilateral non-invasive physiologic investigations on the arteries in the upper or lower extremities
  • 93926 Duplex imaging of the arteries in the lower extremities or arterial bypass grafts
  • 20552 injections into one or more muscle groups, one or more trigger points
  • 20553 injections, one or more muscle groups, three or more trigger points 
  • 20605 Aspiration, injection, or arthrocentesis
  • 20610 Arthrocentesis, aspiration, or injection 


More articles

I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder. I am certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and by the Practice Management Institute (PMI) as a Certified Medical Office Manager (CMOM). As an office manager/biller/coder, I was a member of the Michigan Medical Group Managers, Michigan Medical Billers Association. I also served as a committee member of the Michigan Osteopathic Association of Practice Managers Education Committee.

Latest article