07/04/2013    Marc Katz, DPM

E/M with Nail Debridement Codes

I wanted to help clarify the use of E&M codes
with routine foot care. Podiatrists have
routinely been in the habit of automatically
billing an E&M code whenever they rendered
routine foot care. Under the current Medicare
rules that would be considered fraud and the OIG
is currently investigating podiatrists who make
this a practice.

Some of those people end up as the headliners on
PM News! These podiatrists also ruin it for
everyone else who stays up-to-date on coding
rules and regulations. Whether you believe it is
fair or not has no bearing. It is the law if you
are a Medicare provider.

So, if you provide routine foot care according to
Medicare guidelines then you may be bill an
11721. The only time that you can bill an E&M
code with 11721 is if the patient actually comes
in complaining of another problem unrelated to
the routine foot care. You will then need to add
a -25 modifier and then Medicare may do a pre-
payment audit and check your notes to make sure
you actually had good reason to add a visit

If the patient does have another problem then you
must have full documentation in your chart
including a separate chief complaint, HPI, ROS,
Exam, Diagnosis and Treatment. It would also be
wise to do a follow-up before the next routine
care visit for the new problem. Please also note
that you are not automatically qualified to bill
higher level codes. If someone has a simple
condition that requires basic treatments you may
only be doing a 99212. If someone has a painful
toe that's infected and you work it up and give
them an antibiotic that may be a 99213.

Please read the Medicare guidelines. Our
profession has many resources and seminars to
help with coding. The last thing we need is for
podiatrists to abuse and lose E&M codes!

Marc Katz, DPM, Tampa, FL, dr_mkatz@yahoo.com

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