Billing and Coding Questions

[347932]

I thought it might be a good idea to start a billing and coding thread as when I was coming up there was a sore lack of teaching on how to bill and get paid for our services. Happily in both my residencies, the doctors I worked with were very helpful in teaching me this, but I hear the complaint that new practitioners are not very savvy in this regard. This can be the difference between making a living or not.

Disclaimer: I will try to answer questions as best as I can, but will only give somewhat general information. The APMA do have billing/coding specialists who can help you as well.

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[PADPM]

I thought it might be a good idea to start a billing and coding thread as when I was coming up there was a sore lack of teaching on how to bill and get paid for our services. Happily in both my residencies, the doctors I worked with were very helpful in teaching me this, but I hear the complaint that new practitioners are not very savvy in this regard. This can be the difference between making a living or not.

Disclaimer: I will try to answer questions as best as I can, but will only give somewhat general information. The APMA do have billing/coding specialists who can help you as well.

I'm not sure I agree with you. Since the majority of this site is dedicated to students and residents, and not really to practicing DPM's, I believe that would really be crossing over to more of a practice management type of forum.

Additonally, since coding issues differ dramatically from state to state, etc., I believe that unless someone is truly a coding specialist, there can be some well intended but inaccurate advice given.

I understand that young practitioners often don't understand the nuances of correct billing, but that's a tricky business and can be pretty controversial, and I'm not sure that this site is really the venue for that topic.

Chances are that if you ask 10 different doctors you have the potential of receiving 11 different responses.

Just my opinion.

 

[347932]

I'm not sure I agree with you. Since the majority of this site is dedicated to students and residents, and not really to practicing DPM's, I believe that would really be crossing over to more of a practice management type of forum.

Additonally, since coding issues differ dramatically from state to state, etc., I believe that unless someone is truly a coding specialist, there can be some well intended but inaccurate advice given.

I understand that young practitioners often don't understand the nuances of correct billing, but that's a tricky business and can be pretty controversial, and I'm not sure that this site is really the venue for that topic.

Chances are that if you ask 10 different doctors you have the potential of receiving 11 different responses.

Just my opinion.

Well,

I do believe that there are cerain standards across the board that apply to practice in general. Things that the average Podiatrist out of residency SHOULD know, but they haven't been taught.

Things like global periods and what can be billed outside of that like certain complications and x-rays. Another example is how to bill for at risk care and not commit fraud and land yourself into a whole heap of trouble. Even if the advice is "safe" it may still have value.

Even though I may not be a "coding specialists", its my butt on the line if someone else is filling in those codes for me.

And as I mentioned in the disclaimer, I will be the first to suggest seeking other advice from a more competent person in that regard.

This thread is not meant to be gospel by any stretch of the imagination. My hope is it will stimulate some interesting discussion and be a place where people can exchange ideas about their experience in dealing with the coding and billing side of things.

As you pointed out, if you ask ten different practitioners you may get ten different answers, but the bottom line is getting paid for what you do in an ethical way and avoid getting thrown in the slammer.

If I can help someone get paid for their hard work, that would great.

 

[PADPM]

Global periods often differ among different insurance companies and "at risk foot care" guidelines also not only differ from company to company, but also differ among some Medicare carriers.

Some private carriers don't even recognize "at risk foot" care, nor do they recognize certain modifiers associated with at risk foot care. Therefore, a LOT of answers will have to be very general and generic and may not even be applicable.

Regardless, in my experience, there aren't that many young "in practice" doctors seeking that information on this forum. The majority of those seeking information are students or in training. If they are asking billing questions, it's a little pre-mature, since by the time they get out and actually start billing, the rules will most likely change, since they seem to change on a regular basis.

But if you have the time, knock your socks off, I personally don't believe this is the best forum for that information. I believe that in the few instances those types of questions are asked, you or any of the experienced docs are always available to answer.

 

[krabmas]

I love how all billing and coding discussions turn into how to get paid for cutting toe nails.

The APMA coding and billing course is tailored to it.

The ACFAS billing and coding course is as well, even though they call it a surgical billing course.

I have yet to go to a billing/coding course or workshop that tells you how to bill for a triple arthrodesis - is it 3 procedures or one? If you do a STJ fusion and TN fusion but no CC fusion is it a double fusion or 2 different procedures.

What do you have to diagnose your patient with to get reimbursed for flatfoot reconstructive surgery.

I understand that this may not be what the majority of pods are doing in the country, but I would hate to not get paid for several hours worth of work and all the post-op care with out being reimbursed.

If I miss one payment from a schnided nail patient who cares - that was 15 minutes.

I tell all my nail patients that the service may not be covered under their insurance, whether I think it should be covered or not. This way if they get a bill they were made aware.

I have no problem cutting toe nails if there is a medical reason for it. I am not in a practice where it is affordable for pt to have their nails cut for cash. The big medical group makes up the price which is prohibitively unaffordable.

Podiatry is probably the most informed medical specialty as students and residents when it comes to billing and coding. Talk to some of your MD collegues and see what they knew coming from residency. I recently did a new doc orientation with 12 MDs most just finished residency. They did not even know what an E/M code was.

You can learn some in residency, but ultimately when in practice you get a billing and coding book, read the rules and fight when denied. Learn from your mistake and move on to the next denial.

 

[Feli]

I could be wrong, but isn't the CodingLine APMASilver subscription that comes with APMA membership a quasi-forum (listserv email system) for coding questions?

https://cert.codingline.com/register6.htm

Does anyone use it, and what have you thought? I signed up just recently... most of it is still over my head, but between reading that periodically and looking at the copies of billing sheets I usually try to get from the offices I visit, it's starting to make more and more sense.