Key Podiatry Coding Mistakes You Should Avoid Making

Key Podiatry Coding Mistakes You Should Avoid Making

Staying up to date with the Podiatry billing and coding standards will help to reduce errors in claims and thus improve revenue growth for practices.

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Podiatry medical coding involves the use of the correct patient diagnoses codes, procedure codes and modifiers to get paid for the services provided. Doctors of podiatric medicine (DPM) may have to go through time-consuming claim submission tasks. Personalized coding, errorless procedures as well as other challenges make podiatry billing a complex one.

For better reimbursement for podiatrists, here are some coding mistakes coders should avoid.

Assigning outdated codes Podiatry claims should only be submitted with the correct CPT codes that correctly align with the proper ICD-10 codes. If a patient has more than one condition, several diagnosis codes may be required. Coders must be aware about the insurer’s standards regarding which codes to use.

For clear knowledge about diagnosis as well as procedure codes in the Podiatry specialty, coders are also recommended to undertake specific training in foot care. Such training helps them to know what to document as well as local and national coverage determinations.

Based on the changing coding standards, appropriate ICD-10 codes must be assigned on the claim form. As the 11th Revision of ICD is expected to go into effect on January 1, 2022, coders must also be prepared for this revolutionary transition.

Using wrong modifiers Evaluation and Management (E/M) Coding is of great concern, as often coders get confused here. Three specific evaluation and management (E/M) modifiers are -24, -25 and -57. Only these modifiers should be used with E/M services. Using them with any other service will lead to claim denials. E/M codes are reimbursed separately rather than bundled together for one payment.

Use of the 25 modifier is the most confusing one. Make sure to use this modifier when the E/M service is “significant and separately identifiable� from the procedure you are performing on the same day. Remember not to bill an E/M service every time you perform a procedure as some sort of a baseline office fee. Excessive use of this modifier will flag you for an audit.

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To use the right modifier, coders can check the Correct Coding Initiative (CCI) edits, available at the Centers for Medicare and Medicaid Services (CMS) website or in a podiatry-focused resource such as the American Podiatric Medical Association (APMA) Coding Resource Center.

Not checking for any podiatry coding updates The healthcare industry is constantly changing, and podiatry is no exception. Coding changes are updated each year for this specialty too and coders should be aware of these changes for correct reimbursement from insurers without any delay. More changes are happening in Podiatry coding standards and any practice could lose revenue if they are not applying the changes.

For instance, coding and billing staff must be aware of the Medicare Physician Fee Schedule, which includes several significant policy and payment changes. Awareness about such guidelines reduces the burden of paperwork practices face when billing for Medicare.

Unbundling services improperly Unbundling refers to breaking down the base procedure and billing each of the component parts results in a much higher payment than billing the overall comprehensive code. However, unbundling to obtain a higher reimbursement can be considered as fraudulent billing.

When two procedures are performed at two different anatomical sites, they can be bundled together and are payable separately. For instance, an arthroplasty code and a bunion code can be bundled together if you are not using any modifiers. With the appropriate modifier, bunion procedure and arthroplasty procedure can be properly paid.

Not reading the explanation of benefits (EOB) Explanation of Benefits (EOB) is a printed message from the insurer about the status or action taken on a claim. It is ideal to learn from explanation of benefits (EOB) to appeal and reduce claim denials. Carefully reading the explanation of benefits will provide insight about why the claim was denied and it gives the podiatrist the basis for an appeal. It will indicate whether you can appeal a claim or re-bill them, based on the error that occurred.

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Down-coding Mistakes Billing for a lower level code or down coding is also a mistake. At the same time, upcoding indicates that you are billing for a higher level of service than is appropriate. It is a misconception that by down-coding or by billing for a lower level code, practices will decrease the odds of being audited. Down coding will lead to more loss in revenue. It is ideal to bill for what is done and prepare the chart notes ready to back up your billing.

Billing staff must also indicate the proper place of service (POS) in the claim submitted. It is ideal to verify the HCPCS code with the Durable Medical Equipment (DME) carrier and explain the various options for obtaining DME to patients along with the financial implications. An experienced medical billing company can even turn a negative denial experience into a positive one for practices.

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