10/09/2024    Paul Kesselman DPM

Code for What You Do

Dr. King's article, "Code for What You Do" in the
current issue of Podiatry Management, is exactly
what providers should be doing. This article is
exactly what my recent Letter to The Editor
suggests. Don't be afraid to bill the level 3-5
visits, so long as the medical decision making or
time elements are properly documented. Don't be
afraid to bill anything you do, so long as you
have documented it. Those who have niche
practices, will be outliers. Is it so bad to be an
outlier if you have a subspecialty area you mostly
provide services within? No, just document those
services well according to the policy and you
should be fine, especially at the higher levels of
appeal.

Auditors, especially at your payer level are paid
to fail you. They don't get a pat on the back
if they just pass you. This is also true at the
RAC level. But you can't let the system bully you
and that's exactly how the system works. If you
want to fight back, get your ducks in a row
to begin with. Get your documentation right from
the start. If you feel you are right, fight back
and appeal. It may cost you time and money, but it
costs the carrier time and money as well. You may
think it's not worth the time for one claim, but
if you capitulate to that one claim, your name
will no doubt be passed on and you will have a
larger target on your back. Making things even
worse for yourself and your colleagues.

My ortho and derm have never billed less than a
99214 for an established visit, even for a one
site issue (e.g., shoulder or knee), so why is
that DPMs are so concerned? It's because others
before have either been afraid, or they have
failed these audits due to poor documentation. If
our documentation is correct as a specialty, the
audits will stop! Why? Because it costs the
contractors money to audit and if they see they
are not getting a return on their investments,
they will move on to something or somebody else.
Stop being the low hanging fruit! You can fight
back in your own little way and it will go a long
way!

Paul Kesselman, DPM, Oceanside, NY

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