Billing

Can an Unlicensed Individual Perform Nail Debridements Under the License of a DPM and Can the Service be Billed to Medicare?

What are the new rules that went into effect on January 1, 2022 for the removal of hardware? I am not sure whether to bill for the removal of an implant or for the removal of a foreign body. How do you distinguish between an implant and a foreign body?

I was discussing with my biller verruca follow-ups. Most of these are #15 blade debridements in the process of reducing the hyperkeratosis and verrucous tissue to allow topical medication to work. With most of these, as I am managing the attempted eradication of the wart, I bill a 99212 (I am a conservative biller). However, you hear colleagues (most of the time it’s not good) talking about using 17110 (Destruction of benign lesion. In its description it states surgical curettement and by destruction I would assume this means removal. So I don’t think 17110 is the appropriate code to bill. What are your thoughts? The other one is 11300, which is shaving benign lesions: Is this appropriate for verruca? I am thinking this is more shaves for biopsies. So, in the end, am I stuck using 99212 for verruca follow-ups such as I have described? Or is there another option?

What are the guidelines and documentation requirements for X-rays being performed in a podiatrist’s office?

“My clinic is at the local hospital. I send X-rays to the radiology department. They are eventually read by a radiologist. However, I actually evaluate the x-rays and interpret them myself. Can I bill that component of the radiology fee? And if I do, will it affect radiologist reimbursement?”

“I am in practice and would like to figure out a different way to contain and manage my routine foot care. It is approximately 15% of my practice. I would like to designate one morning a week as a routine foot care clinic. I am considering making this a cash only clinic: $50 for toenails and $50 for calluses. Is this possible? I am a Medicare provider and have contracts with most insurance companies. I was hoping to model my cash clinic on what some nurses in the area have done. They visit a nursing home and offer residents $25 for routine foot care and do not work with any insurance companies or Medicare. Any thoughts on this cash model, routine foot care clinic would be appreciated.”

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”

“I’m trying to determine the coverage of diabetic shoes for a patient who has had one foot/leg amputated. Somewhere in my brain I seem to remember that Medicare will cover a pair of shoes so the amputee can wear the shoe on his prosthetic. Does this also apply to heat moldable inserts? Can we dispense them for the shoe that will be used on the prosthetic leg? I would appreciate any thoughts on this situation. I have read the LCD and associated article but can’t seem to fully understand how this works.”

“Is the debridement of a plantar keratosis (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”

“I just received a letter from Cigna insurance. As of August 13, 2022, they will require the submission of office notes with claims submitted with Evaluation and Management/E and M codes (ie. 99212, CPT 99213, CPT 99214) appended by modifier -25 when a minor procedure is also billed the same day by the same physician. The E/M will be denied if documentation is not received. The claim can be sent electronically with attachment indicator and notes should be faxed. Is this happening with other insurance companies? The amount of paperwork for a small office is crazy and along with continued decreasing reimbursements, higher prices for supplies, shortages, etc. The insurance companies are making greater profits than ever. The insurance premiums have increased and out-of-pocket patient billing has become more significant. The system is not right. What can we do? How do we fight back? Please don’t say take cash rather than insurance, it’s not practical in many circumstances. Any thoughts?”