Podiatrists are specialists in diagnosing and treating diseases and the function of the ankle and foot. The process of medical billing for podiatry is complicated because procedures and treatments associated with the foot are extremely specific due to the medical necessity requirement and restrictions on the conditions that may be treated. 

Additionally, most experts in doctors and medical billing firms understand that insurance companies have their own specific and very rigid regulations for coverage regarding nail debridement, treatment for calluses and corns, flat foot, bunions, and other conditions that make it challenging to obtain approval for claims. To get the most reimbursement possible, podiatrists should be aware of the coverage requirements as well as the best codes for their treatments and be sure to provide clear documentation.

The first is to be aware of the latest changes in coding. In 2022, the AMA introduced a number of major changes to podiatry codes, which included deletions, additions, and revisions. Changes to the CPT code for Podiatry effective January 1, 2022.

Podiatry Medical Billing

The two codes added were:

• 28291 28291 Hallux rigidus correction using debridement, cheilectomy as well as capsular release from the metatarsophalangeal articulation; using an implant
• 28295 or 82995-Correction, hallux valgus (bunionectomy) by removing the ethmoidectomy; and with osteotomy of the proximal metatarsal, any technique

Codes deleted

3 bunionectomy codes were eliminated in January 2022 to remove the appropriate names from the descriptions, like Austin, McBride, etc. Also, they correctly define the procedure in the current way it is performed:

• 28290 Correction. hallux valgus (bunion) either with or without ethmoidectomy, simple exostectomy (e.g., the Silver-type procedure)
• 28293 Correction, hallux valgus (bunion) either with or without ethmoidectomy Resection of the joint using implants
• 28294 Correction of hallux valgus (bunion) whether or not with or without ethmoidectomy. tendon transplants (e.g., Joplin-type procedure).

Codes updated

• 28289 28289 Hallux fixation of the rigid us without implants. Note: This procedure was previously performed with or without an implant. However, 28291 (see above) was added to the procedure using an implant.
• 28292 Bunionectomy with ethmoidectomy Resection of the base of the proximal phalanx
• 28296 Bunionectomy with ethmoidectomy and distal metatarsal bone osteotomy (new code 28295 is used to refer to proximal metatarsal osteotomy See the previous paragraph)
• 28297 Bunionectomy) and ethmoidectomy. The first metatarsal and medial joint arthrodesis
• 28298 Biunionectomy with ethmoidectomy, an osteotomy of the proximal phalanx.
• 28299 28299 Bunionectomy) Sesamoidectomy and two osteotomies
• +77002 – Fluoroscopic guidance in needle positioning (e.g. aspiration, biopsy, or the localization devices) (List separately, in the code for the principal procedure). Note: The description previously given did not define this as an added-on.

Codes that have been deleted

The following CPT codes were eliminated:

• 28290-Correction. Hallux valgus (bunion) including or not sesamoidectomy simple exostectomy (eg the Silver-type procedure)
• 28293-Correction, hallux valgus (bunion) either with or without sesamoidectomy the resection of joint by an implant)
• 28294-Correction, Hallux Valgus (bunion) including or not sesamoidectomy; and with tendon transplants (eg, Joplin-type procedures)

Know Coverage Policies

Medicare Part B (Podiatry Medical Billing) covers podiatrists for medically required treatment of foot injuries or conditions such as hammertoes, bunion deformities, and heel spurs. Part B typically does not provide coverage for

Treatment of Flat Foot

Routine Foot Care, e.g. cutting or removing calluses and corns, cutting, trimming, cutting, or debriding nails, hygienic, or any other preventive maintenance like washing and soaking feet

Supportive devices for feet: Medicare will not cover orthotics and other support devices for the feet except if they are an integral component of leg braces, and their cost is included in the price of the brace. A narrow exception covers orthotics and inserts for diabetic patients in certain cases.

Typically, Medicare pays for 80 percent of the cost and the rest is paid by the patient, and there are deductibles that apply. In an outpatient hospital setting, patients must also pay a copayment to cover medically needed treatment.

A few exceptions: Medicare may cover routine foot treatment when an underlying condition(s) that are related to neurologic, metabolic, or peripheral vascular diseases, result in severe embarrassment for the circulatory system or areas of reduced sensation in the feet or legs.

Podiatry Medical Billing Practice The following are also covered:

Warts treatment (including plantar warts) on the feet.

If there isn’t any systemic disease, the treatment of mycotic nails could be covered. The treatment of mycotic nails for an ambulatory patient/non-ambulatory patient is based on the provider’s documentation.

Value-based Reimbursement and Podiatrists

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) seeks to integrate Value-based payments within Medicare’s Medicare system. In the context of MACRA payment reforms, podiatrists, like other providers, have the option of choosing between two payment models, one of which is the Merit-Based Incentive Systems (MIPS) or an alternative payment model like an accountable care organization (ACO) or a patient-centered medical home or Bundled Payments. 

Based on an article that was published in Podiatric Economics in 2016, the decision on the question of which option is the most effective will vary between podiatrists, and most of the time the decision will be determined by aspects like the practice’s location, its patient population, and its EHR setup (or absence of it).

Although private insurance companies will continue to pay on a fee-for-service model, experts say the growth of tiered health plans indicates that private insurance companies are starting to consider the payments. In this ever-changing reimbursement environment, it is imperative that podiatrists be proactive in protecting their bottom line.

Beware of errors in coding In the latest report from Becker’s ASC Review, the coding mistakes that are common in Podiatry Medical Billing and other specialties are:

• Coding is based on the title of the surgical note instead of reading the note body, which results in the absence of other billable procedures during surgery.
• Coding is not of the highest quality or accuracy.
• Not coding bilateral procedures for bilateral procedures
• Codes are not being used to allow multiple procedures if allowed.
• Making a mistake or using a non-specific diagnosis code
• Unbundling or up-coding
• Inability to add enough modifications
• The code is not correct for billable equipment or equipment use.
• Not using the most current/updated code sets

Podiatric practices can remain at the top of their game by outsourcing medical billing to an experienced expert. Professionally trained health billing firms have teams of experts in coding who keep up-to-date with changes in codes and guidelines. They will also collaborate with doctors to adhere to best practices in order to aid them in maximizing the amount of reimbursement.

Other actions podiatrists may use to boost reimbursement include making sure there are a variety of payers within the practice as well as establishing other businesses that are ancillary to the practice. It is recommended that doctors not let any plan have more than one-third of the reimbursements of their practice. Podiatrists also offer a variety of services to increase their income. According to the study in Podiatric Economics, some practices provide Botox injections, sell orthotics, and other services that can be lucrative outside of Medicare. They use the Medicare system to generate more income for their clients.