Why do certain podiatry codes get bundled?

 Erika Regulsky Coding, podiatry
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The Reason why Bundling in Podiatry Coding is challenging for healthcare

Podiatry billing and coding is a challenge and receiving too much bundling, inclusive, not paid separately denials will only prevent getting payment for genuinely provided services to the patient.

Identifying CMS and payer guidelines to prevent these types of podiatry code bundling is a priority for any podiatry practice trying to ramp up its revenue cycle. Catching up with these guidelines is essential but most billers and coders tend to skip this part and create room for bundling denials. Let us break down some of these bundling scenarios and methods to avoid them.

Scenarios where bundling occurs frequently:

Usually, routine foot care services and procedures are excluded from Medicare coverage except for the following situations, conditions, and medical history of the patient:

An integral and necessary part of otherwise covered services

  • Treatment of ulcers and diagnosis, infections, or wounds.
  • Cutting nails or trimming following a fracture to be fitted with a cast (a separately billable service if a cast is included)

Systemic conditions present in a patient:

A neurologic, metabolic, or peripheral vascular disease that would need scrupulous foot care by a podiatry healthcare professional.

Warts on foot condition treatment:

Warts on foot treatment including plantar warts are only covered to the same extent as services rendered for treatment of warts on the body located elsewhere.

Mycotic Nails:

A systemic condition absence and mycotic nails treatment mat only be covered, when the following condition criteria are met:

Ambulatory patient

  • Mycosis of the toenail clinical evidence
  • The limitation of ambulation is marked under the patient’s encounter. Secondary infection and pain and thickening and dystrophy resulting from the infected plate of the toenail.

Patient is non-ambulatory

  • Clinical evidence of mycosis of the toenail.
  • Secondary infection or pain suffered by the patient resulting from the dystrophy and thickening of the toenail plate infection.

Routine foot care services and related covered exceptions to are considered medically necessary 60 days once.

Routine foot care services and related treatment performed more frequently than every 60 days will be denied unless the medical records, charts, and other documentation are submitted with the claim in order to prove medical necessity and substantiate the increased frequency.

Guidelines and codes for routine foot care and steady gadgets for the feet are not solely for the utilization of Podiatrists. These codes should be utilized to report foot care benefits no matter what the specialty of the doctor who outfits the administration. Doctors ought to involve the most fitting code accessible while billing for routine foot care.

Moderately couple of cases for schedule-type care are expected to consider the seriousness of conditions thought about as the reason for this exemption. Claims for this kind of foot care ought not to be paid in that frame of mind of persuading proof that nonprofessional execution of the help would have been perilous for the recipient in light of a basic fundamental sickness. The

simple explanation of a conclusion, for example, those referenced above doesn’t itself demonstrate the seriousness of the condition. Where improvement is demonstrated to check determination as well as seriousness, records might be mentioned to survey the set of experiences and clinical states of the patient as well as any doctor contacts for the executives of those circumstances.

Modifiers utilized to denote Class A, Class B, and Class C findings:

  • Use Q7 Modifier for Class A finding one point required.
  • Use the Q8 modifier for Class B findings two points are required.
  • Use Q9 modifier Class C findings one Class B and two Class C findings required.

Procedure codes these modifiers may be used with are 11055, 11056, 11057, 11719, 11720, 11721, or G0127. The podiatry provider must document in the medical record when a Q7, Q8, or Q9 modifier is used the appropriate signs and symptoms as outlined in Class Findings A, B, and/or C along with the complicating conditions.

The fact that most payers subject certain codes as bundled or not paid separately is because the underlying condition is inconsistent with the codes or procedures billed with or due to the patient’s post-operative care if any major foot surgery has been performed. Utilizing an experienced coder and biller who has already faced these types of bundling denials frequently will be able to solve these issues easily.

However, most podiatry practices do not have a dedicated podiatry experienced coding or billing to tackle this problem. The best solution is to identify a well-experienced RCM services-providing company that has good podiatry client references when you reach them you can obtain a surety by gathering feedback on the podiatry coding and billing services provided by that RCM services-providing company.

BillingParadise is one such company that is very well-experienced and known for its podiatry billing and coding services. Our dedicated podiatry RCM team will be assigned to your practice where designated supervisors will be communicating with you on the day-to-day billing and coding operations and make sure all the codes and claims are audited before submission to reduce bundling denials and increase revenue.

Schedule a call with our podiatry RCM team to learn more!

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.


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