Podiatry Coding & Billing Alert

Question: If a patient comes in, but they don’t meet the criteria to bill for routine foot care procedures (i.e. nail debridement, callus removal, etc.), can I still bill for an office visit (i.e 99212) since the patient was still seen and examined, was educated on their diabetes status, and were told what to look out for by the podiatrist? Or would it be the 11721-GZ (no ABN on file) and an evaluation and management (E/M) code shouldn’t be billed at all?

Florida Subscriber

Answer: According to Jennifer McNamara, CPC, CCS, CRC, CPMA, CDEO, COSC, CGSC, COPC, director of healthcare training and practice support at Healthcare Inspired LLC. Bella Vista, Arkansas: “You may still bill an E/M service such as 99212 [Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making]. In regard to reporting the routine footcare code 11721 [Debridement of nail(s) by any method(s); 6 or more], you will want to append modifier GY modifier [Item or service statutorily excluded, does not meet the definition of any medicare benefit] since they did not meet the requirements for a covered benefit. You will also want to combine it with modifier GX [Notice of liability issued, voluntary under payer policy] if you decide to give a patient an ABN form as a courtesy to notify them. For statutorily excluded services you do not need an ABN form, but you may choose to provide one. The line item will deny and be moved to patient responsibility.”