Podiatry Billing Services

Podiatry is a medical specialty that deals with diagnosing and treating diseases, injuries, and defects of the human foot. Podiatric medicine involves diagnosing, medical and surgical treatment of disorders of the foot, ankle, and lower extremity. This specialty also includes medical, surgical, mechanical, and physical treatments of the foot. Podiatry billing can be complicated in many ways, beginning with the need to determine and prove the treatment's medical necessity to the coding nuances.

A Significant number of Podiatry claims get denied because of termination of coverage by the payer, the services provided are not being covered, or the maximum benefit for Podiatry services has already been provided. Insurance Details can change at any time, and we check the insurance & coverage details each time. Our team also ensures that the patient is aware of the insurance treatments non-covered by the insurance, thereby preventing further denials. We ensure HIPAA compliance at all stages of the billing & coding process.

Best Practices in Podiatry Billing & Coding

Prior Authorization. Authorization denials are common in Podiatry. It is necessary to obtain prior authorization from the payer and submit the claim and the authorization number to get reimbursements.

• Referring provider. Codes for the provider should be added below the CPT codes while billing for Medicare.

• Accurate coding. Accurate medical coding is an essential requirement for clean claim submission. Based on the payer's guidelines, the provider can bill for additional procedure codes with other codes separately.

• Medical Necessity. The coding team should be skilled in billing using the right CPTs & diagnosis codes as per the guidelines. The codes must verify NCD (National coverage determinations) & LCD (Local coverage determinations). Coding documentation should also support the medical necessity of the services and treatment billed. Good documentation will subsequently help in appealing unpaid claims.

• Inclusive Services. Most claims get denied as the procedures are counted as inclusive. Please note:

  • Providers should not bill CPT codes 11719, 11721 & G0127 together to avoid inclusive denials.

  • If the insurance company denies the claim even after using correct modifiers, CCI (Correct Coding Initiative) edits should be checked and appealed with appropriate medical records.

• Frequency of Services. Routine foot care services are considered medically necessary once in 60 days. Payers will deny frequent services within 60 days, as they view it as unreasonable and unnecessary. Providers can appeal such claims for reimbursement with necessary medical documents stating the necessity of the services.

• Use of Q Modifiers. Submitting claims using Q modifiers indicate the findings related to the patient's condition. Q7, Q8, and Q9 are used to bill podiatry services.