Podiatry Coding & Billing Alert

Be sure you know the limitations of the staff performing services.

If you are considering adding a pedorthist to your practice, or even if you already have one on staff, you need to familiarize yourself with their role and limitations to ensure you are billing correctly for their services.

Read on to learn more about the services pedorthists are allowed to perform, those that are beyond their scope, and gain tips on providing documentation to improve reimbursement on your orthotic claims.

What Is the Difference Between a Pedorthist and a Podiatrist?

There are an estimated 18,000 pedorthists currently working in the United States. They are allied health professionals specifically educated and trained to manage comprehensive pedorthic patient care. Their abilities include patient evaluation, formulation of a treatment plan, implementation of the treatment plan, continuation of the treatment plan, and practice management.

The field of pedorthics involves the management and treatment of conditions related to the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. Not only do pedorthists design and fabricate the appropriate orthotic for the patient, but they also provide each one with personalized attention while selecting and modifying shoes and inserts for the patient to wear the orthotic correctly. Pedorthics use footwear to help ease and treat these foot-related problems. In short, they focus on the alignment, structure, and other mechanical aspects of the foot.

Podiatrists, on the other hand, are medically trained to diagnose, treat, and prevent diseases, disorders, and injuries that can affect the foot and ankle. They are also able to perform surgery and prescribe medication after reviewing a patient’s medical history, performing a physical examination, and determining the patient’s current health condition.

What Services are Pedorthists Allowed to Perform?

A pedorthist is allowed to do a variety of tasks related to foot care and orthotics. They are able to assess and evaluate the foot conditions of patients and provide recommendations for appropriate footwear and orthotic devices. They are also allowed to design, fabricate, and modify custom-made orthotics to address specific foot issues, and educate patients on proper foot care and footwear selection.

Further, pedorthists can collaborate with other healthcare professionals, such as podiatrists and physical therapists, to develop comprehensive treatment plans and conduct gait analysis to assess how a patient walks and moves. They perform foot measurements and fittings for orthotic devices and are required to stay up-to-date with the latest advancements in foot care and orthotics through continuing education and professional development.

Here are just a few examples of services pedorthists may bill for:

• L3010 (Foot, insert, removable, molded to patient model, longitudinal arch support, each)
• L3020 (… longitudinal/ metatarsal support, each)
• L3030 – (… formed to patient foot, each)
• L5000 – (Partial foot, shoe insert with longitudinal arch, toe filler)

What Are Pedorthists not Allowed to Do?

A pedorthist should not provide services that are outside the realm of foot care and orthotics. They should stay within their professional boundaries and refer patients to other appropriate healthcare providers when necessary. They are not authorized to diagnose medical conditions or provide medical treatments beyond their scope of practice. This means they are not allowed to perform or bill for surgical or invasive procedures or prescribe medications.

They also cannot perform treatment modalities that are outside of their scope of practice.

For example, pedorthists may not bill for therapeutic procedures such as:

• Manual therapy using 97140 (Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes)
• Therapeutic exercises like 97110 (Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility), as those are typically provided by a physical therapist or physician.

Tips for Billing Pedorthist Services in Your Practice

To improve your claim approvals, you must have clear and concise medical documentation and to show proof of medical necessity for the orthotics and any visit with the pedorthist. This includes understanding the coverage requirements, which codes you should report, and what information to include in the medical documentation, according to Lisa Addison, provider outreach and education specialist at CGS Administrators, a Medicare Administrative Contractor (MAC).

Whether you are billing for an office visit with a podiatrist, or an orthotics fitting with the pedorthist, it’s important that the payer can easily understand and agree with the medical necessity of the visit. “When you report orthopedic footwear in your podiatry practice, you should always make sure that you meet the documentation requirements,” says Addison. These include the following: