Coding

“What are the Most Common Medicare and Medicaid Audits and Which One is the Least Aggressive?”

“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?”

“Three of the podiatrists in our group have joined together to open a wound care center. They have a licensed LVN on staff that performs wound dressing changes, Arobella wound care treatments and things of that nature. Are we able to charge the E/M code 99211 as a "nurse" visit if the doctor is not on site? Any advice or recommendations are greatly appreciated.”

“I did a house call yesterday on a patient under at-home hospice care. She had a diabetic wound on the foot that I provided care for. I also did routine care as she has Q7 findings. She is covered by an Aetna Medicare Advantage Plan. I have a couple of questions.

“How can I get full reimbursement for office ultrasound from United HealthCare?”

“Can a dystrophic nail trim be coded without using Routine Foot Care rules? For example, there is a patient with dementia whose dystrophic nails had grown so long that they were causing pain. The patient would only allow a professional to trim them. The nails were documented as dystrophic rather than fungal, so we couldn't bill 11721. The patient also had no systemic conditions. The podiatrist billed G0127 and 99203. What are your thoughts on using G0127 or a similar code in this situation? An Advanced Beneficiary Notice of Non-Coverage (ie. ABN) was not obtained.”

“I'm in PA, and this is an 80-year-old patient..... Cigna denied both charges stating the diagnosis codes do not support the procedure (as per what my billing company told me). This was before we were notified that notes must be sent in with all Cigna claims where an E&M is billed with a procedure.