12/03/2024
RESPONSES/COMMENTS (CODING & BILLING)
From: Alan Bass, DPM, CPC
I think a better question should be “what is needed in an encounter note for the services provided at the visit?” As a certified professional coder, it is my opinion that if the patient encounter will be coded for an evaluation and management, the documentation should follow the E&M guidelines that have been adopted by the AMA, utilizing medical decision-making (MDM) or time. If the patient encounter is for a procedure and being coded as such, there should be a description of the procedure, instrumentation used, instructions for the patient (if needed), etc.
An audit can be subjective depending on what the auditor is looking for. You may have one auditor “ding” you on one thing and another auditor may not. I think the best advice I would give is... document as if the chart will be part of a malpractice case. Because of the subjective nature of an audit, I don’t believe that anyone can point to information that must be there and will preclude an adverse finding on any audit.
Alan Bass, DPM, CPC, Manalapan, NJ
11/26/2024
RESPONSES/COMMENTS (CODING & BILLING)
From: David J. Freedman, DPM
The AOFAS has adopted the term “progressive collapsing foot deformity" in part because of the difficulty in being reimbursed for a diagnosis of “flatfoot".- Allen Jacobs, DPM
As Chair of the APMA Coding committee, we submitted an application in May of 2021 to the National Center for Health Statistics, ICD-10 Coordination and Maintenance Committee located in Hyattsville, Maryland. We explained progressive collapsing foot deformity using clinical references and peer-reviewed literature, then detailed why the organizations deserved its own set of ICD-10-CM codes. The term “progressive collapsing foot deformity" has been widely accepted, evidenced by the fact it...
Editor's note: Dr. Freedman's extended-length letter can be read here.
11/22/2024
RESPONSES/COMMENTS (CODING & BILLING)
From: Charles Morelli, DPM
Don't bill for a "flatfoot", but rather bill for the patient's conditions that either are instrumental in having caused the flatfoot, or are a painful sequela of the flatfoot. I don't believe I have ever had a "flatfoot patient's" claim denied as I have yet to see a flat foot that doesn't have one or more of the following: an equinus, PTT dysfunction, PT tendonitis or partial tear, os naviculare, ligament laxity, LLD, or degenerative joint disease. Using any of the above should result in your claim not being rejected.
Charles Morelli, DPM, Mamaroneck, NY
10/29/2024
RESPONSES/COMMENTS (CODING & BILLING) - PART 2
From: Richard J. Manolian, DPM
Suggesting that a group of codes should be created that would be useful to designate unequal foot length or foot width is a reasonable request. But I’m tired of not seeing an ICD code for hammertoe for all the toes and laterality; and amputation codes need an update with osteomyelitis being the primary causative agent, not trauma as it exists now, among others.
Richard J. Manolian, DPM, Southbridge, MA
10/29/2024
RESPONSES/COMMENTS (CODING & BILLING) - PART 1
RE: UrgoK2 Compression System
From: Eric J. Lullove, DPM
One of the first things you need to know about the Urgo K2 and similar multi-layer compression systems is this — they are Compression Systems! These are not “Unna boots” or other type of archaic compression garment. These products are FDA approved DMERC Stage 2 Surgical devices and dressings.
There are other brand-names on the market (3M, Milliken, Coloplast, Hartman, Essity in addition to Urgo) and they are all treated the same under a single CPT code for physician application: 29581. The typical ICD-10 codes for this product application will be the I87.3xx series and I89.1.
You can bill these adjunctive to an E/M service and they also are independent of wound debridement services. You MUST document the venous hypertension with or without inflammation and ulcer or secondary lymphedema, and have measurements of the affected calf and ankle. Also - do not bill these products as 29580 — they are NOT Unna boots. Also, applying an Unna boot and adding multiple layers does not qualify the multi-layer compression CPT code. The CPT was specifically created for this product group, and once an Unna boot is applied, the 29580 is primary.
Eric J. Lullove, DPM, Coconut Creek, FL
10/05/2024
RESPONSES/COMMENTS (CODING & BILLING)
Query: Medicare Bundling
I have been told by my billing executive that when billing Medicare, if you do a procedure like a hammertoe procedure, and then within the next three months, you do a shortening osteotomy of the metatarsal, Medicare will bundle both of them together and not pay you on the second procedure. I have now seen this a few times. Is this legal, and is there a way around this from a modifier standpoint?
Peter J. Bregman, DPM, Las Vegas, NV
07/18/2024
RESPONSES/COMMENTS (CODING & BILLING) - PART 1B
From: Michael G. Warshaw, DPM, CPC
CPT code 11730 is defined as the following: "Avulsion of nail plate, partial or complete, simple; single." Unfortunately, it is one of the most frequently audited CPT/procedure codes due to the improper performance and documentation of this procedure. Here are the important facts regarding the performance and documentation of CPT code 11730:
1. Documentation must describe the symptoms and complaints which establish medical necessity for the treatment.
2. Nail or nail border must be separated and removed to and under the eponychium.
3. Local anesthetic (type and quantity) must be documented. If not used, provide rationale (i.e. neuropathic patient, patient refused, medical contraindications).
4. Post-operative instructions and follow-up care should be documented.
5. If the medial and the lateral borders are...
Editor's note: Dr. Warshaw's extended-length can be read here.
07/18/2024
RESPONSES/COMMENTS (CODING & BILLING) - PART 1A
From: Steven Finer, DPM, Jack Ressler, DPM
This is a procedure that Medicare likes to crucify podiatrists. Look up the exact wording that Medicare uses and repeat it. Always use anesthesia, bandages, etc. They will accept a typewritten procedure note in lieu of handwritten notes.
Steven Finer, DPM, Philadelphia, PA
Anytime I had a Medicare audit, I got in touch with my malpractice carrier (PICA). They referred me to one of their healthcare consultants. It happed to be Robert Weatherford. If you have legal defense with your malpractice carrier, you must get in touch with them to go over your audit. Do NOT take this on yourself. They will go over your charting, billing, etc. and guide you through the audit. The CPT 11730 procedure code is one that I'm sure Medicare still scrutinizes closely.
You do not want your 4 chart request to turn into a bigger sampling once Medicare receives your charts, especially if you are billing this procedure more frequently than your peers. You are correct in your process of typing your handwritten charts without any alterations. If Medicare cannot read a handwritten chart, some auditors will not give you a favorable ruling. I had to do that with one of my audits. Back when I had to submit charts, the general advice I got was to submit both the original handwritten chart along with the typed version.
Jack Ressler, DPM, Delray Beach, FL
07/15/2024
RESPONSES/COMMENTS (CODING & BILLING)
From: Meredith Dickson, DPM
Vicki- if you’ll refer to the multitude of emails sent out from the NCFAS, this is widely discussed. The new Palmetto ruling absolutely affects podiatry. If patients are not seen by an MD or DO within 6 months of their RFC appointment, it is no longer a covered service. Most offices I have spoken to are either rescheduling these patients or having them sign an ABN for non-covered services at the time of their RFC appointment. There are letters explaining the situation for patients and providers both on APMA's website, and that have been sent by NCFAS.
Meredith Dickson, Asheville, NC
04/18/2024
RESPONSES/COMMENTS (CODING & BILLING)
From: Wayne Feldman, DPM, Kristin Happel
It’s business as usual. I'm a solo practitioner who does his own claim submissions. After the Change Healthcare issue, I started using Availity to submit claims for horizon BCBS, blue card claims, Aetna, etc. Payments arrived within 2-3 days. United has its own site to submit claims. No issues.
Wayne Feldman, DPM, Fair Lawn, NJ
I was dealing with two practices that use the Change clearinghouse. One was smart, and sent their claims on paper within a week or so of the hack, and then switched clearinghouses as soon as possible, when it became evident that Change wasn't going to be up and running any time soon. They are doing fine. The other practice just kept holding out, and because they weren't prepared with cash flow, they are now out of business. Keep waiting, or make a change. Your call. Only you know what your practice is prepared for.
Kristin Happel, Podiatry Biller, Chicago, IL
