Denial of a podiatry claim is at best, upsetting for the doctor and staff. At worst, it’s an unexpected cost, which if ignored and continually repeated over time can reduce the value of your business. Taking the time to correct these errors and educate staff will lead to proper payments in the future. Long term will reduce the stress associated with billing corrections, increase revenue and decrease one’s audit exposure. There are 8 common billing mistakes, which corrected can improve the growth of your business.
1. Incorrect CPT-ICD-9 Codes
It’s essential that each individual CPT code correctly aligns with a proper ICD-9 code. If a patient has more than one condition, several ICD-9 codes may be required. Be sure to check with the carrier about which codes are allowed.
2. Physical Therapy
Always check with the carrier for benefits, deductibles and policy limitations before proceeding with providing physical therapy treatments. The order should list the diagnosis, treatment modalities, frequency of treatments, goals, and the expected duration. Never submit claims for modalities that patients can apply or use themselves.
3. X-Ray Reimbursement
Only take the number of x-ray views medically necessary and reasonable. Also, ensure thorough documentation of all x-ray views taken. Be sure to use appropriate diagnosis codes for an x-ray service.
4. Durable Medical Equipment (DME) Documentation
Generally, home is the proper place of service (POS). To ensure accurate reimbursement this must be submitted correctly on the claim form. Always verify the HCPCS code with the DME carrier and be sure to explain the various options for obtaining DME to patients along with the financial implications.
It’s important to verify prior to surgery whether or not prior authorization is required. Check with each carrier about the software it employs to bill properly for the services performed. The proper use of modifiers is also very important.
6. Routine Foot Care
Due to the multiple Medicare carriers, coding for routine foot care that raised blood pressure can be very confusing. Be careful to clearly list and align at-risk conditions and painful conditions with the appropriate ICD-9 codes on the claim form.
7. Evaluation and Management (E/M) Coding
Use of the 25 modifier is a common area of confusion. Make sure to use this modifier only when indicated.
8. Casting Reimbursement
When a cast is applied at the time of surgery, it is included in the surgical allowance and is not payable separately. Supplies are only payable with a diagnosis of a fracture or a dislocation.
It is important to continually monitor one’s billing practices. Being aware of new changes in policies and learning from errors can go a long way toward avoiding repeat claim denials.
Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.