Wiki Hand x-rays done by a podiatrist

[tamale79]

Well, here's another fun one - A pod ordered hand x-rays for a patient, and my billing manager wants me to make "100% sure" that we can't charge for it. I told her I'm sure b/c he's a podiatrist and cannot legally treat a hand problem, right??
But I figured I would double-check just in case.
Also, does anyone know where I can find documentation that specifically says pods can only treat feet and ankles??
Thanks

 

[thomas7331]

Scope of practice is determined by your state's medical licensing board - that's where you'd find the documentation that would spell out the limitations on a particular provider's practice. However, ordering is not the same as treating - I'm not sure there'd be a problem with ordering the x-ray, as long as the podiatrist isn't interpreting the results or making a diagnosis or treatment plan from it. However, your state medical board would have the final say on something like this.

 

[tamale79]

Well, he's trying to charge for the x-rays (which is what I have a problem with), not just order them for someone else to read. And he did dictate his interpretation into the patient's note.

 

[thomas7331]

Well, he's trying to charge for the x-rays (which is what I have a problem with), not just order them for someone else to read. And he did dictate his interpretation into the patient's note.

I think you have a legitimate concern, but normally it's not within a coder's scope to monitor whether or not a provider is acting within the scope of their own practice. (This may be a simple case here, but imagine, for example, if coders were responsible for deciding what complex procedures a general surgeon or cardiologist were or were not qualified to perform.) As a coder, you code and bill what they perform. If this is an insolated instance and the provider isn't doing this all the time, personally I wouldn't put too much time and effort into it. The payer will deny it if their system detects that it's not within the credentials of the provider type.

But if your manager expects you to make this determination, then if I were in your place I would starting by reviewing your state medical board's web site to see if the podiatry scope of practice is published, and if you don't find the answer there, then call the board and ask them.