Podiatry Coding & Billing Alert

When patients come in for an problem-focused visit and your podiatrist performs an unrelated minor procedure such as a toe nail trim, you're leaving deserved pay in the table if you don't report that procedure. Read on for advice on how to accurately capture these separate services on your claims. For instance: "Podiatrists can get paid for 11721 (Trimming of nondystrophic nails, 6 or more) and 99212 (Office or other outpatient visit) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same say of the procedure or other service)," says Paul Fehring of Drs. Central Billing, LLC in Fairfield, OH, Dx codes are key: Make sure you have "separate and identifiable diagnosis codes," says Fehring." "Modifier 25 is a target for audits, so be sure to totally document the ICD-9 codes and the time spent."

The correct coding for this situation would be:

• 99212 (Office or other outpatient visit) with modifier 25 and a diagnosis of 845.00 (Sprains and strains of ankle and foot, unspecified site)

• 11730-T5 (Avulsion of nail plate, partial or complete, simple; Single; right foot, great toe) with 703.0 (Ingrowing nail)

• 73600-RT (Radiologic examination, ankle; 2 views; right side) with 845.00 (Ankle, unspecified site).

"Be sure you match the ICD-9 codes and the CPT codes as indicated in the above scenario," says Fehring. "Also, do not use the same ICD-9 with the E/M and procedure."

Again, in the scenario above, this would communicate that the 99212 had nothing to do with the 11730 and should be paid separately. "Keep in mind that some insurance companies will automatically deny an E/M with procedure and these must be appealed with documentation that the 99212 was not for the ingrown nail complaint," Fehring explains. "Modifier 25 is justifiable because one service has nothing to do with the other and multiple services were performed."

Arnold Beresh, DPM, CPC of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. adds that to justify  the diagnosis of 845.00 that the documentation must include the date and time of the sprain or the claim will be flagged. "The physician simply needs to make a note in the patient's chart that 'to the patient's most accurate recollection, the injury took place on X date at X time.'

Here's another example of a situation where you'll need modifier 25 to accurately describe a separate service performed during a problem visit for heel pain. The patient presents with heel pain and you indicate heel pain (729.5) as the chief complaint (per E/M guidelines). Your physician then evaluates the complaint and suggests looser shoes (management). For this you would report 99213 (Office or other outpatient visit). The patient also has a separate condition, such as an ulcer (707.14) on another part of the foot that the physician addresses and treats during the same visit, and you would add 11040 (Debridement, skin partial thickness) with substantiating documentation in the patient record.

Documentation needs to indicate that the patient was treated for both heel pain and wound debridement. "Modifier 25 is appended to the 99213 because there is an additional procedure that the patient was seen for," says Hoda Henein, CHBME, CPL, president and CEO of Active Processing, Inc. in College Point, NY. "Again, keep in mind that Medicare will not pay for both services together and will probably only pay for the 11040 unless you add a modifier 25 to the 99213," says Henein Here's a summary of the codes for the above scenario: