Podiatry Coding & Billing Alert

The nature of podiatry procedures places increased importance on documentation compared to other specialties. Here are some highly audited areas to pay particular attention to:

• E/M codes with a 25 modifier, “the number one audit issue,” said healthcare attorney J. Kevin West in an APMA presentation. The “significant” aspect of “significant, separately identifiable E/M service” is subjective. Support your claims with documentation.
• Nail debridement (11720 [Debridement of nail(s) by any method(s); 1 to 5], 11721 [Debridement of nail(s) by any method(s); 6 or more])
• 11730 (Avulsion of nail plate, partial or complete, simple; single)

          o Documentation must describe symptoms and complaint that establishes medical necessity.
          o Make sure you precisely list the type and dose of the anesthetic used. And if it’s not used, document the reason why.
          o Document post-op and follow-up instructions.

• I&D of abscess (10060, 10061)
• Paring of skin lesions (11055, 11056, 11057)
• Orthotics codes
• Modifier 59 (Distinct procedural service)
• Injection codes (Morton’s neuroma, plantar fascitis)
• Wound care codes

          o Always indicate the size, grade, depth and appearance of ulcers and wounds.
          o Indicate tissue or material removed from wound, which determines your code.
          o Chart the location of the wound.
          o Document type of anesthesia.