All You Need To Know About Podiatry Medical Billing Services

Touseef Riaz

January 26, 2022

Podiatry Medical Billing Services
Before getting into the podiatry medical billing services, let us first see what Podiatry is? We can define podiatry as a medical specialty that focuses on diagnosing and treating human foot-related injuries, diseases, and defects. So, if you want the diagnosis, surgical or medical treatment of foot, ankle, and lower extremity disorders, podiatric medicine is what you need.

In addition, this medical specialty also involves mechanical, medical, physical, and surgical treatments of the foot. All the billing services related to foot disorder come under the podiatry medical billing services.

There are several reasons that make podiatry medical billing complicated. The first and foremost challenge is determining and proving to the coding nuances that the medical treatment of the given disorder is necessary. Other than this, Medicare provides for the elderly population. Therefore, practices with podiatry services mainly treat this population, necessitating additional billing & coding efforts. In addition, podiatry medical billing also requires a meticulous use of modifiers and good comprehension of coding for procedures that are inclusive.

Medical practices that offer podiatry usually tend to hire a third-party billing company or an in-house team of coders who have experience in podiatry billing. This is because many practices lack the ability to record, track and rectify unpaid or underpaid claims. Therefore, medical practices often opt for outsourcing their billing & coding needs to reliable & successful billing companies like UControl Billing. We are among one of the best billing and coding companies in the US. With our expertise and best medical billing specialists, we identify and correct key issues in Podiatry billing and coding in order to improve your collection rate and reduce the denial rate.

Podiatry Medical Billing

Challenges In Podiatry Medical Billing and Coding

Many challenges and hurdles are subjected to podiatry medical billing. It faces many issues in medical coding. Here are a few of the challenges that are faced in podiatry billing:

Not Able To Distinguish Medical Necessity From Routine

The insurer does not pay for regular foot care, but in podiatry, there is some sort of regular condition that may not need any treatment for one patient, but it might be serious for others and require proper medical treatment. In such cases, the coders are required to be experienced and also specialized in order to determine the appropriate claims.

Payer’s Inconsistent Use Of Modifiers 

The subcategories of codes are known as modifiers. Modifiers basically provide the details of diagnosis and treatment. In addition, modifiers determine if the condition or the treatment is covered or not. The insurer of podiatry has different rules for the modifiers used in podiatry coding and billing. Therefore, it is important that your podiatry medical billing service provider has a coder that has the knowledge of what modifiers every company uses to determine the coverage.

Insurers Bundling Procedures Inaccurately 

In order to make podiatry billing and payment methods less complex, payers tend towards bundling procedures into one coded item. Sometimes, these bundling procedures cause mistakes in billing or may result in under or over-coding. This is why outsourcing pediatric medical billing services is essential. Our medical billing specials understand the procedures performed, thereby determining whether the bundles are correct and when they are incorrect. Additionally, our experts know how to correctly enter data as well as how to handle when non-payments occur.

Podiatry Billing And Coding Differ As Location Changes 

Payers are provided with different podiatry medical billing guidelines for each. It is known that the procedures and treatments related to podiatry are sometimes performed in offices, hospitals, and nursing homes as well, and this leads to more complexity in the podiatry medical billing services. In order to avoid claim denial, it should be ensured that the correct modifier is used to indicate where the treatment occurred. Similarly, an incorrect code will indicate the wrong location resulting in a conflict and claim rejection.

Best Practices For Correct Podiatry Billing & Coding

Prior Authorization

Prior authorization is very important, as, in podiatry, authorization denials are very common. Therefore, it is better to get prior authorization from the payer. There are high chances of reimbursement when you submit the claim along with the authorization number.

Referring provider

Another good practice is to refer to the providers while billing. It can be done as below the CPT codes provider’s codes should be added in podiatry billing for Medicare.

Accurate coding

In order to submit clean claims, a crucial requirement is accurate medical coding. According to the payer’s guidelines, providers can bill separately with the other codes for additional procedures.

Medical Necessity

The coding team for podiatry medical billing service should be specialized as well skilled coders of CPTs and codes for podiatry evaluation and treatment. It is important that all codes must verify Local coverage determinations (LCD) and National coverage determinations (NCD). The medical necessity of the treatment and the service that is being billed should be supported with coded documentation.

Inclusive Services

When procedures are counted as inclusive many claims get denied. This way, it should be noted that in order to avoid inclusive denials, CPT codes 11719, 11721 & G0127 should not be billed together. And even if, with the right modifiers, an insurer denies the claim, then one should check the Correct Coding Initiative (CCI) edits.

Frequency of Services

For once in 60 days, one can go for routine foot care services, but if the visits are more frequent than that, then the payer will deny paying for that. In such case-relevant medical records stating the obvious reason for frequent visits should be sent to the payer in order to get full reimbursement.

Use of Q Modifiers

In order to get podiatry medical billing and coding right, use Q modifiers to indicate the finding of the patient’s condition while submitting the claims. The modifiers Q7, Q8, and Q9 are used for podiatry medical billing services.

Guidelines For Podiatry Medical Billing Services

Here is a guideline that every podiatry medical billing services provider should follow:

  1. In order to submit correct claims, ensure that it includes the following:
  • Diagnosis and its intensity
  • Name of the podiatrist
  • Visit date of a patient

It should be noted that routine foot care service provided by a non-podiatrist won’t be reimbursed. Only the services that come under the payer’s coverage will be reimbursed.

  1. In order to avoid claim denials, ensure proper utilization of codes—this is why outsourcing podiatry medical billing services are necessary to manage the claim process.
  2. Follow correct coding procedures also avoid over-coding while filing claims. Another point that should be kept in mind is that from patient to patient, codes do not change.

What Is Not Covered By Podiatry Services?

Medicare does not cover all foot care services, whereas there are chances that some third-party insurance company does cover them. Therefore, it is important to know which services come under coverage and which do not because if you get the services that do not come under coverage, then reimbursement will be impossible. Read on to know what are the services that the payers do not cover:

Regular Foot Care

The first is regular foot care services known as routine foot care, which Medicare does not cover. These foot care services include the following:

  • Removal of calluses and corns
  • Cutting of calluses and corns
  • Usage of skin creams to keep an even skin tone
  • Clipping, trimming, and debriding of nails
  • Cleaning and soaking the feet

Flat Foot

The second condition is not covered in the flat foot. A flat foot is a condition in which one or both feet are flattened out. In such conditions, the services and devices that are prescribed do not come under any sort of insurance coverage.

Supportive Devices for Feet

Insurers do not cover the devices like orthopedic shoes and other such items. Medicare can cover only a fundamental part of a leg brace. Other than that, there are very rare chances of coverage of special shoes and injections for diabetic patients.

Why Choose UControl Billing For Podiatry Medical Billing Services?

UControl’s podiatry billing and coding experts take charge of follow-ups of each and every claim that starts from the first entry till the submission of claims. Our podiatry billing services include the following.

  1. Enrollment of demographic and insurance information into the system
  2. Verification of insurance and authorizations
  3. Correct podiatry coding
  4. Billing and reconciling of accounts, including charge entry, cash posting, reconciliation.
  5. Taking care of all accounts receivable collections, such as insurance and patient collection.

Why UControl Billing Is The Best Medical Billing Company?

Here are the factors that make UControl billing the best Podiatry billing service provider:

  • HIPAA-compliant service
  • Flexibility with using software
  • Cost-effective Coding
  • Regular updates on coding compliance
  • Improved collection ratio and productivity
  • Timely appeals for denials and incorrect claims
  • Quick turnaround time
  • No hidden costs
  • 24×7 customer service

The podiatry billing and coding specialist at UControl Billing are knowledgeable and experienced in their field. They keep track of the changes in the codes to ensure that a higher average return per claim is processed. To know more about services, feel free to contact us at any time and enjoy the most affordable medical billing services in the US.

Frequently asked questions (FAQs)

Here are the questions that are frequently asked when it comes to podiatry medical billing:

What is podiatry billing?

Podiatry can be described as a medical specialty that diagnoses and treats the human feet and ankles. Different conditions that come under a podiatrist’s care are:

  • Heel spurs
  • Toenails
  • Fallen arches
  • Foot/ankle injuries
  • Plantar fasciitis

The Services that pediatrics offers should be paid for by either patients or insurance companies or by both parties. Podiatry medical billing and coding is an essential as well as a crucial part of many practices. The podiatry medical billing services are mainly concerned about collecting money from potential payers or insurers that are responsible for covering the services, procedures, or treatments offered by podiatrists.

The medically needed services are the only services that payers and insurers cover. The rest of the podiatric services that are for routine foot care might not be covered. In order to obtain repayments, many practices opt for outsourcing podiatry medical billing services from companies like UControl Billing.

How do you code podiatry?

For appropriate podiatry coding, one needs to follow proper guidelines. Proper modifiers with proper CPT codes are very important for podiatry medical coding. The modifiers Q7, Q8, and Q9 are used with the list CPT code for podiatry evaluation and treatment given below

  • 76881: Ultrasound, extremity, nonvascular, real-time with image documentation
  • 76882: Limited ultrasound, extremity, nonvascular, real-time with image documentation
  • 93922: Non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral
  • 93926: Duplex scan of lower extremity arteries or arterial bypass grafts
  • 20552: Injections(s), single to multiple trigger point(s) one or two muscle(s)
  • 20553: Injections(s), single to multiple trigger point(s) three or more muscle(s)
  • 20605: Arthrocentesis, aspiration, and/or injections
  • 20610: Arthrocentesis, aspiration, and/or injection

What are medical billing services?

Medical billing services include the processes involved in the submission and follow-ups of health insurance claims via a third party to save your staff time. The companies that provide medical billing services have professional and trained staff that have the knowledge of individual payers. These experts work with practices keeping in mind the policies to obtain a higher level of payment in a shorter amount of time. The medical billing company that you decide to outsource from also ensures follow-ups on rejected claims and pursues delinquent accounts.

What is the top denial reason for services provided by a podiatrist?

The top reasons for denied podiatry claims are the patient’s ineligibility. Therefore, in order to avoid fallouts, it is important to verify whether the patient does actually needs foot care or not. The other reason that causes the denial in Podiatry medical billing services are the challenges faced when patient billing occurs.

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