Expert Podiatry Billing Services for Your Practice

We specialize in providing comprehensive podiatry medical billing services that allow you to focus on what matters most – your patients. Our expert team understands the unique challenges and intricacies of podiatric billing and is committed to improving your revenue cycle while ensuring compliance and accuracy in every step.

Common Podiatry CPT Codes

Below are some commonly used CPT codes for podiatry services:

Surgical Procedures:

• 28010: Excision of a benign tumor (includes excision of soft tissue or bone).

• 28285: Bunionectomy with distal metatarsal osteotomy.

• 28296: Hallux valgus correction (bunion surgery with or without osteotomy).

• 28615: Open reduction of metatarsal or phalangeal fractures with or without internal fixation.

• 11056: Paring or cutting of benign hyperkeratotic lesions, 2 or more lesions.

• 11057: Paring or cutting of benign hyperkeratotic lesions, 2 or more lesions, extensive.

• 11719: Debridement of toenails (includes trimming and removal of nail and surrounding tissue).

• 11720: Removal of nail plate (e.g., partial or total).

• 11830: Excision of ingrown toenail, partial (with or without a matrixectomy).

Ankle and Foot Surgery:

• 27650: Tendon lengthening (posterior tibial tendon for flatfoot).

• 27652: Tendon transfer of the foot or ankle.

• 28485: Arthrodesis (surgical fusion) of the foot or ankle, including joint removal.

• 28510: Repair of a fracture of the metatarsal bone (closed or open).

Podiatric Orthotics:

• 97597: Removal of cast or splint (if it's medically necessary, like in foot or ankle injuries).

• 97760: Orthotic management and training, including custom-made orthotics.

Injection and Other Therapies:

• 20550: Injection of tendon sheath or ligament, single tendon.

• 20551: Injection of tendon sheath or ligament, multiple tendons.

• 64450: Injection of anesthetic agent to the foot for nerve block.

Wound Care:

• 11042: Debridement of a wound, skin (subcutaneous tissue) only.

• 11043: Debridement of a wound, skin, and subcutaneous tissue.

• 97602: Removal of devitalized tissue or wound dressing with or without the use of a vacuum-assisted closure device (VAC therapy).

Diagnostic Services:

• 99203: New patient, 30-44 minutes, moderate complexity (typically for initial consultation for a condition or injury).

• 73600: X-ray, foot, complete, 2 views.

• 73610: X-ray, foot, multiple views, including the toes.

• 76881: Ultrasound of the ankle joint or foot for diagnostic purposes.

Other Codes:

• 95990: Podiatric neurodiagnostic testing (nerve conduction studies or electromyography of the foot/ankle).

• 99070: Supplies used in podiatric procedures (non-surgical).

Podiatry Medical Billing Best Practices

To ensure accurate and efficient billing, keep the following in mind:

• Accurate Diagnosis Codes (ICD-10): Make sure to match the diagnosis code with the correct treatment.

• Thorough Documentation: Ensure all patient interactions and treatments are thoroughly documented to support the codes submitted.

• Payer Requirements: Different insurers may have specific rules for submitting claims. Always confirm payer-specific requirements to reduce the chance of denials.

• Timely Filing: Submit claims as soon as possible to avoid any issues with claim acceptance and reimbursement.

Insurance Coverage and Reimbursement

Podiatry services are typically covered by most major insurance plans, including Medicaid, Medicare, and private insurers. However, reimbursement rates and coverage may vary based on:

• The specific condition being treated

• The patient's insurance plan

• Whether the service is provided in-network or out-of-network It’s important to verify insurance coverage before providing treatment to ensure that services will be covered and that the correct billing codes are used.

Our Denials and Appeals Process

Medical claim denials are a common challenge in podiatry billing. Our process:

• Understanding the Denial Reason: Denials could be due to incorrect coding, insufficient documentation, or missing information. We thoroughly review the insurance company’s reason for denial and address it appropriately through various modes of response.

• Appeal Process: If the claim is denied based on coverage or medical necessity, an appeal may be necessary. We review the insurance company’s appeal process and act quickly to submit it and reduce potential delays or timely submissions.