PODIATRY
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.
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.