Are you missing reimbursement opportunities due to coding mistakes? You might not realize it, but an improper coding process can damage a practice’s revenue stream and affect its daily operations. While podiatry is a less stressful specialty compared to others, it has high denial rates due to complex coding requirements.
Coverage restrictions, frequent use of modifiers, and the need to prove medical necessity for most procedures make the coding process more difficult. But what if we tell you that you can avoid these pitfalls through regular training and proper education? The first step is to familiarize yourself with the latest podiatry CPT codes. But first, let’s understand podiatry and how different insurance companies, especially Medicare, cover podiatric services.
Understanding Podiatry
Uncomfortable shoes, aging, and diabetes can cause severe foot problems. Podiatry is the medical specialty for all types of lower leg issues. It addresses a wide range of conditions, including bunions, diabetic neuropathy, athlete’s foot, plantar fasciitis, ingrown toenails, and more. However, due to podiatry’s unique procedures and services, its coding significantly differs from other medical specialties.
What Exactly Is Covered? Medicare vs Other Insurance Providers
Before coding and submitting medical claims to different providers, you should understand the coverage limitations to avoid financial problems. Medicare and private insurers have different guidelines for podiatric services. For example, Medicare only provides reimbursements for medically necessary foot care services, such as:
- Chronic foot conditions
- Wound treatments
- Surgeries
Hence, it declines reimbursements for routine foot care procedures, such as nail debridement (CPT codes 11720 and 11721) without a nail infection. Most private insurance companies may follow the same guidelines. However, some providers have different policies and specific coverage exclusions. So, always verify coverage limitations before providing any service.
Common Podiatry CPT Codes
As you can see, coding in podiatry is not a simple task. In addition to dealing with various foot and ankle issues, podiatrists must also follow specific coding guidelines to receive complete payments. Moreover, they must stay updated with the frequent changes. A single coding error can lead to a cycle of rework, inefficient operations, and staff frustration.
However, you can improve your coding efficiency by understanding the following frequently used CPT codes in podiatry.
Podiatry CPT Codes for Initial Check-Up (New Patient)
CPT Code 99203 – E/M Visit (30 minutes)
This podiatry CPT code covers an initial check-up. Billing specialists use the 99203 CPT code to specify that a podiatrist has evaluated a new patient for 30 minutes. Healthcare providers usually use this appointment to make standard decisions.
CPT Code 99205 – E/M Visit (60 minutes)
The 99205 podiatry CPT code covers a complex evaluation and management visit. Podiatrists use this CPT code to bill a 60-minute appointment with a new patient. Doctors use this visit to make advanced medical decisions.
Podiatry CPT Codes for Routine Check-Up (Established Patient)
CPT Code 99213 – E/M Visit (20 minutes)
The 99213 podiatry CPT code is used for evaluating established patients. Podiatrists use this code to specify that they have spent 20 minutes on a regular patient check-up. They use this follow-up visit to make basic adjustments to improve the foot health of a patient.
CPT Code 99214 – E/M Visit (30 minutes)
This CPT code for podiatry covers a 30-minute follow-up visit. Podiatry specialists use the 99214 CPT code to bill an evaluation and management service provided to an established patient. They use this appointment to make intermediate decisions.
Podiatry CPT Codes for Nail Treatment
CPT Code 11720 – Nail Debridement (1 to 5 nails)
Fungal conditions and ingrown nails can cause pain or discomfort. The 11720 CPT code is applied to bill the debridement of up to five nails. During this process, podiatrists reduce the thickness and length of a patient’s abnormal, diseased, or infected nails.
CPT Code 11721 – Nail Debridement (6 or more nails)
The 11721 podiatry CPT code also addresses a nail debridement procedure. Billing specialists apply this code when podiatrists debride six or more nails of patients with severe issues.
CPT Code 11730 – Nail Plate Avulsion (Removal)
Have you ever removed a patient’s nail plate due to an injury or trauma? Then, you can apply this code to receive reimbursements. The 11730 CPT code is categorized under surgical nail procedures. Billing experts use this code to report that a podiatrist has partially or completely removed a single nail plate of a patient using basic avulsion techniques.
CPT Code 11750 – Partial or Complete Nail Excision
Ingrown nails, fungal infections, and nail deformities may require nail excision – surgical removal of a nail. The 11750 podiatry CPT code specifies this procedure. Billing experts use it to report complete or partial removal of a toenail, including the underlying nail matrix, to prevent regrowth.
Podiatry CPT Codes for Corns & Calluses Treatment
CPT Code 11055 – Single Benign Hyperkeratotic Lesion (Corn or Callus)
Ill-fitting shoes and autoimmune diseases can cause hyperkeratosis in the feet. The 11055 CPT code for podiatry procedures covers the treatment of benign hyperkeratotic lesions, including corns and calluses. You can use this code to report the surgical removal of a single hyperkeratotic lesion.
CPT Code 11056 – Benign Hyperkeratotic Lesions (2 to 4 lesions)
This podiatric CPT code also falls within the paring or cutting procedures on the skin. Podiatrists use the 11056 CPT code to notify payers about the surgical removal of two to four harmless hyperkeratotic lesions via a scalpel or curette.
CPT Code 11057 – Benign Hyperkeratotic Lesions (more than 4 lesions)
This podiatric CPT code also highlights the treatment of corns and calluses. You can use the 11057 CPT code if you have removed more than four benign hyperkeratotic lesions.
Podiatry CPT Codes for Fracture or Dislocation Treatment
CPT Code 28450 – Closed Treatment of Tarsal Bone Fracture without Manipulation
This podiatry CPT code covers one of the fracture or dislocation procedures on the foot and toes. Healthcare providers use CPT code 24580 to bill for the closed treatment of a tarsal bone fracture. This procedure is performed without a surgical incision and manual realignment of the bone.
Instead, podiatrists use a cast to immobilize the fractured bone and promote healing. In short, this CPT code only addresses treatments that involve casting rather than surgical or manual adjustments. However, keep in mind that this code specifically addresses the treatment of five tarsal bones (excluding the talus and calcaneus) located in the middle or back of the foot.
CPT Code 28455 – Closed Treatment of Tarsal Bone Fracture via Manipulation
The CPT code 28455 also covers the closed treatment of a tarsal bone fracture in a patient. Instead of casting, podiatrists manually adjust or realign the broken bone to promote proper healing. Like 28450, this code also does not cover the talus (bone connecting the foot to the leg) or the calcaneus (heel bone) fractures.
CPT Code 28510 – Closed Treatment of Phalanx/Phalanges Fracture
The podiatry CPT code 28510 specifies a non-surgical treatment for a fractured toe bone (excluding the big toe) without any manipulation. During this procedure, podiatrists use a cast to stabilize the phalanx or phalanges to promote healing.
Podiatry CPT Codes for Amputations
CPT Code 28805 – Foot Amputation
This podiatry CPT code refers to a popular foot amputation procedure. Healthcare providers use CPT code 28805 for severing the foot across the metatarsal bones – five bones located between the ankle (tarsal) and the toe bones (phalanges). This type of amputation is often performed due to severe injuries, diseases, trauma, or other conditions.
CPT Code 28820 – Toe Amputation
The 28820 CPT code points towards a toe amputation procedure. In this process, healthcare providers cut off a toe at the metatarsophalangeal joint. This joint connects the toe with the foot, or in medical terms, it is the point between the first metatarsal of the foot and the first phalanx of the toe. Podiatrists usually amputate toes to prevent the infection from spreading to other areas.
Podiatry CPT Codes for Orthotic Services
CPT Code 97760 – Prosthetic Training
This CPT code reports prosthetic training. Podiatrists use CPT code 97760 to indicate that they have guided patients on how to use a prosthetic device. During this session, they test and adjust the fit of the device and create a treatment plan for the patient.
Billing specialists use this code to cover each 15-minute session during the initial meeting where they assist patients with their orthotic devices.
Bottom Line
Don’t fall into the repetitive cycle of denial management and resubmissions. We understand that it is quite difficult to accurately code each podiatric procedure or treatment, especially with varying coverage limitations and evolving requirements.
However, you can significantly reduce your coding problems by familiarizing yourself with the most common CPT codes for podiatry. Outsourcing is another solution. Choose one of the top podiatry billing services, for example, MediBill MD, to minimize the risk of denials.
Medical billing companies can perfectly read between the lines, and hence, they accurately translate the performed podiatric services and procedures in medical claims.
