Coding

Routine Foot Care, which includes trimming or debridement of asymptomatic dystrophic, mycotic or normal toenails, is covered by Medicare only when the patient has one of the Medicare-specified systemic diseases with clinically significant peripheral complications placing the patient “at risk” for infection and/or injury if a non-professional attempts to trim or debride the nail.

“We have a handful of patients who have traditional Medicare with a secondary we don't participate with. Is it ok to tell them we don't participate and bill them what Medicare says is patient responsibility? If asked, do we need to provide anything so they can file on their own? Each visit the amount Medicare doesn't pay is about $30. This is adding up. We use NextGen and in searching their Payer List these little secondary companies aren't listed.”

"My associate doctor recently billed for a hospital outpatient surgery on 08/13: 28005 and 11981. The antibiotic spacer kept displacing during the post op period, so he went back earlier than expected on 10/2 to do the following, hence the patient is still in the global period from the first procedures:" in the following article.

One of the more frustrating parts of practicing medicine is dealing with insurance company billing and coding requirements. We perform a service that is medically necessary, document the care provided, submit the claim, and sometimes receive a denial because we failed to meet an insurance company's particular requirements. AI can help physicians and their staff research these policies, identify the requirements that apply to a particular service, and locate the actual documents published by the insurance company. This is one of the practical ways AI can help reduce the administrative burden of running a medical practice.

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“Can I still bill one of the hallux valgus correction codes if I don’t excise the medial aspect of the head of the 1st metatarsal even if I correct the IM angle?”

The annual ICD-10-CM update takes effect October 1, and FY 2027 brings several changes that are particularly relevant to podiatric medicine. Although the overall number of ICD-10-CM changes is substantial, the number of changes directly affecting podiatry is relatively limited.

“Does writing or managing a prescription with moderate-complexity medical decision-making (MDM) for an established patient in a podiatric office qualify for CPT code 99214? Furthermore, if this is correct, do CPT codes 99309 (nursing facility) and 99349 (home or residence visit) apply under the same MDM criteria, and why might those specific site-of-service codes be inapplicable depending on the setting or patient status?”

“We have a provider who wants to do Qutenza patches for neuropathy affecting a patient’s foot. The vendor suggested CPT code 64632. I cannot find anything official to support that code and most of the carriers that do have policies state that there is no CPT code for the application and to list the J code for the medication. Do you have any insight here or anything official that states that CPT code 64632 would be appropriate?”