Wiki Basic overview of podiatry coding

[lgardner]

hello fellow coders-

I am looking for a very basic, layman's overview of podiatry coding (or any other specialty, for that matter).

I am particularly interested in "Class findings". I am reading about the modifiers to use and what falls under each Class, but what is the purpose of the class findings?
are these modifiers only used for "routine foot care" (the procedures listed in the routine foot care coding article A57954)?
or should they be used for other procedures or E/Ms?

thanks for any insight!
- Lisa

 

[podcoder70]

Hello Lisa and welcome to the world of Podiatry coding! Podiatry coding is one of the more complex sets. As such, there are very few if any basic, layman overviews available. CMS outlines in detail the class findings. The requirements are jurisdiction specific and should be detailed in the documentation. The purpose of the class findings is medical necessity showing why foot care is dangerous for a non professional to perform. The Q modifiers are only used for nail and callus treatment and should not be used for e&m codes.
If you would like some additional information feel free to reach out to me, I provide private and group training sessions.

 

[lgardner]

Hello Lisa and welcome to the world of Podiatry coding! Podiatry coding is one of the more complex sets. As such, there are very few if any basic, layman overviews available. CMS outlines in detail the class findings. The requirements are jurisdiction specific and should be detailed in the documentation. The purpose of the class findings is medical necessity showing why foot care is dangerous for a non professional to perform. The Q modifiers are only used for nail and callus treatment and should not be used for e&m codes.
If you would like some additional information feel free to reach out to me, I provide private and group training sessions.

Thank you for the response. It is helpful.

I am reading the appropriate Billing and coding articles for our Jurisdictions (my work involves several different states).

My situation is that I am an experienced E/M FFS coder (with Risk experience, too), but recently took on a new position that is more of an educator role.

This involves me presenting/educating providers and coders from different specialties, most of which I have very little knowledge about.

I will be meeting with a group of podiatrists, next week; they are mostly interested in an E/M refresher, but I want to, at the very least, have a general understanding of their specialty.
It is difficult to get a general "overview" of any specialty, but I am learning.

Since I don't have any specfic questions, I wouldn't know what kind of information to ask for, but I am a resource hound, so if you have any documentation that you feel is important in your field, please private message me.

Thanks again for your response.

 

[podcoder70]

Thank you for the response. It is helpful.

I am reading the appropriate Billing and coding articles for our Jurisdictions (my work involves several different states).

My situation is that I am an experienced E/M FFS coder (with Risk experience, too), but recently took on a new position that is more of an educator role.

This involves me presenting/educating providers and coders from different specialties, most of which I have very little knowledge about.

I will be meeting with a group of podiatrists, next week; they are mostly interested in an E/M refresher, but I want to, at the very least, have a general understanding of their specialty.
It is difficult to get a general "overview" of any specialty, but I am learning.

Since I don't have any specfic questions, I wouldn't know what kind of information to ask for, but I am a resource hound, so if you have any documentation that you feel is important in your field, please private message me.

Thanks again for your response.

I am an educator as well. How exciting! Well, as you know the e&m rules are not specialty specific, so you will be good there. They may ask you questions regarding when it is appropriate to bill and e&m with the procedures. A lot of DPMs bill out an e&m with every nail and callus care and this is incorrect coding. I have seen others put the Q modifier on the e&m, which is incorrect. Feel free to PM me if you have other questions. The APMA has a wealth of information, some of which is available to non members on the web. There are podiatry specific billing/coding pages on FB as well that are very helpful.

 

[lgardner]

I had our podiatry coder send me examples of recent denials, which were all E/Ms with nail procedures. Just like you are saying.

I will definitely reach out with any questions.

thank you.

 

[podcoder70]

I had our podiatry coder send me examples of recent denials, which were all E/Ms with nail procedures. Just like you are saying.

I will definitely reach out with any questions.

thank you.

If those were medicare advantage plans, and the e&m had a 25 modifier, the claim denials most likely have more to do with a recent edit in which the payer is denying to force a re-opening with a copy of the encounter note. They are "testing" the podiatrists' documentation across the board on claims with 25 and 59/XS modifiers.

 

[lgardner]

If those were medicare advantage plans, and the e&m had a 25 modifier, the claim denials most likely have more to do with a recent edit in which the payer is denying to force a re-opening with a copy of the encounter note. They are "testing" the podiatrists' documentation across the board on claims with 25 and 59/XS modifiers.

Interesting.
I will look into that.

From what I have heard from the coders, they are trying to bill for E/Ms that aren't supported.

thanks for the advice.