Staying up to date with the Podiatry billing and coding standards will help to reduce errors in claims and thus improve revenue growth for practices.

1. Key Podiatry Coding
Mistakes You Should
Avoid Making
Staying up to date with the Podiatry billing and
coding standards will help to reduce errors in
claims and thus improve revenue growth for
practices.
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Podiatry medical coding involves the use of the correct patient diagnoses codes, procedure
codes and modifiers to get paid for the services provided. Doctors of podiatric medicine (DPM)
may have to go through time-consuming claim submission tasks. Personalized coding, errorless
procedures as well as other challenges make podiatry billing a complex one.
For better reimbursement for podiatrists, here are some coding mistakes coders should avoid.
Assigning outdated codes
Podiatry claims should only be submitted with the correct CPT codes that correctly align with
the proper ICD-10 codes. If a patient has more than one condition, several diagnosis codes may
be required. Coders must be aware about the insurer’s standards regarding which codes to use.
For clear knowledge about diagnosis as well as procedure codes in the Podiatry specialty, coders
are also recommended to undertake specific training in foot care. Such training helps them to
know what to document as well as local and national coverage determinations.
Based on the changing coding standards, appropriate ICD-10 codes must be assigned on the
claim form. As the 11th Revision of ICD is expected to go into effect on January 1, 2022, coders
must also be prepared for this revolutionary transition.
Using wrong modifiers
Evaluation and Management (E/M) Coding is of great concern, as often coders get confused
here. Three specific evaluation and management (E/M) modifiers are -24, -25 and -57. Only
these modifiers should be used with E/M services. Using them with any other service will lead to
claim denials. E/M codes are reimbursed separately rather than bundled together for one
payment.
Use of the 25 modifier is the most confusing one. Make sure to use this modifier when the E/M
service is “significant and separately identifiable” from the procedure you are performing on the
same day. Remember not to bill an E/M service every time you perform a procedure as some sort
of a baseline office fee. Excessive use of this modifier will flag you for an audit.

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To use the right modifier, coders can check the Correct Coding Initiative (CCI) edits, available at
the Centers for Medicare and Medicaid Services (CMS) website or in a podiatry-focused
resource such as the American Podiatric Medical Association (APMA) Coding Resource Center.
Not checking for any podiatry coding updates
The healthcare industry is constantly changing, and podiatry is no exception. Coding changes are
updated each year for this specialty too and coders should be aware of these changes for correct
reimbursement from insurers without any delay. More changes are happening in Podiatry coding
standards and any practice could lose revenue if they are not applying the changes.
For instance, coding and billing staff must be aware of the Medicare Physician Fee Schedule,
which includes several significant policy and payment changes. Awareness about such guidelines
reduces the burden of paperwork practices face when billing for Medicare.
Unbundling services improperly
Unbundling refers to breaking down the base procedure and billing each of the component parts
results in a much higher payment than billing the overall comprehensive code. However,
unbundling to obtain a higher reimbursement can be considered as fraudulent billing.
When two procedures are performed at two different anatomical sites, they can be bundled
together and are payable separately. For instance, an arthroplasty code and a bunion code can be
bundled together if you are not using any modifiers. With the appropriate modifier, bunion
procedure and arthroplasty procedure can be properly paid.
Not reading the explanation of benefits (EOB)
Explanation of Benefits (EOB) is a printed message from the insurer about the status or action
taken on a claim. It is ideal to learn from explanation of benefits (EOB) to appeal and reduce
claim denials. Carefully reading the explanation of benefits will provide insight about why the
claim was denied and it gives the podiatrist the basis for an appeal. It will indicate whether you
can appeal a claim or re-bill them, based on the error that occurred.
Down-coding Mistakes

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Billing for a lower level code or down coding is also a mistake. At the same time, upcoding
indicates that you are billing for a higher level of service than is appropriate. It is a
misconception that by down-coding or by billing for a lower level code, practices will decrease
the odds of being audited. Down coding will lead to more loss in revenue. It is ideal to bill for
what is done and prepare the chart notes ready to back up your billing.
Billing staff must also indicate the proper place of service (POS) in the claim submitted. It is
ideal to verify the HCPCS code with the Durable Medical Equipment (DME) carrier and explain
the various options for obtaining DME to patients along with the financial implications. An
experienced medical billing company can even turn a negative denial experience into a positive
one for practices.