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. In addition to this, podiatry practices primarily treat the elderly, necessitating additional billing & coding efforts, as Medicare covers this population. It also demands meticulous use of modifiers and an understanding of coding for inclusive procedures.

Podiatrists usually hire an in house team of coders or billing companies that claim to have experience in podiatry billing. Many of these resources often lack the expertise to track, record & rectify underpaid or unpaid claims consistently. Thereby creating a need for podiatrists to shift to outsourcing their billing & coding needs to reliable & successful billing companies with expertise in the specialty. Medical Billing Wholesalers is among the pioneers in podiatry billing & coding services. With seasoned resources and institutionalized best practices, we can consistently improve collections by over 23% and reduce denials by over 25% by identifying & correcting key issues in Podiatry billing and coding.

Applying best practices for Podiatry Billing & Coding 

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 Practises 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 of 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.

Modifier	Description
Q7	One Class A Finding
Q8	Two Class B Findings
Q9	One Class B and Two Class C Findings

Medical Coders may use q modifiers with procedure codes 11055, 11056, 11057, 11719, 11720, 11721, or G012.

Medical Billing Wholesalers’ Expertise in Podiatry Billing Service 

Our podiatry billers & coders’ team stay consistently updated while applying Podiatry coding guidelines and ensure maximum first-pass rate. We have a client base that extends over 50 states covering a wide range of hospitals, physician practices, and medical billing companies. Our coders are proficient in ICD-9/10, CPT, HCPCS coding based on CMS and AMA guidelines and are certified by the American Academy of Professional Coders (AAPC). 

Our Value

We apply Podiatry billing & coding experience to build a competent & denial-free revenue cycle management process. Our team of Podiatry billers & coders concentrate on increasing your collections while helping you emphasize more on providing excellent patient care. We bring you a team of medical billing and coding specialists who are

• CPC Certified by The American Association of Professional Coders (AAPC) and has received training in most common Medical Coding Software
• Successful in processing medical claims with most commercial insurance companies including UHC, WellPoint, Aetna, Humana BCBS, and Anthem, and government payers such as Medicare
• Successful in working with Medicare and understand state-specific Medicaid Policies
• Experts in reducing costs and helping you achieve improved clinical and operational efficiency
• Strong prior authorization and AR Follow-up teams to ensure detailed patient information collection.