08/20/2018    Richard M. Hofacker, DPM

It's Time to Clean Up Our Act (Joseph Borreggine, DPM)

I am the first to believe that podiatrists (and
doctors in general) are completely abused by the
insurance companies. Our expenses continue to go
up, while our reimbursements continue to go
down. Having said that, I recently had a patient
come into my office because she felt she was
being overcharged by another local podiatry
office to the tune of $2,000.

I immediately explained to her that it doesn't
really matter what the physician charges, but
rather what the physician is actually paid by
the insurance company for the services rendered.
Her reply was, "no, I was billed $2,185.83 for
the part that the insurance did not pay." When
I looked at her invoice, I was SHOCKED to see
that she was correct. She assured me that she
did not have a root canal procedure, nor did she
have a stent put into her coronary artery while
she was in the podiatrist's office.

She stated to me that she had her toenails cut
and her calluses and corns were trimmed as well.
Now I must admit, this patient did have a lot of
foot pathology present and I did spend about 15
minutes treating her feet, but my fees were
slightly less than the $2,185.83 she was
previously asked to pay.

As I looked at her invoice from the other doc,
there were codes on there (i.e. 11308) that I
have never used in my 30 years of practice. So,
I am dumbfounded. Is this type of billing the
norm in our profession? My children's 529 plans
have suffered for years due to my lack of
billing creativity. I am dying to know how the
rest of you respond to this, and please inform
the membership what coding seminar we should all
attend to learn this stuff. You know, there is
also the remote possibly that practices billing
like this are actually committing FRAUD. It is
this type of billing the gives all of us in this
profession a black eye.

Richard M. Hofacker, DPM, Akron, OH

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08/23/2018    Name Withheld

It's Time to Clean Up Our Act (Joseph Borreggine, DPM)

I commend Joseph Borreggine, DPM for revisiting
the WSJ physician compare website at:
https://graphics.wsj.com/medicare-billing/
I think it behooves all of us to visit this site
and search your city or geographic area to see
what kind of billing is being done out there.
It is eye-opening and appalling. In my city,
there are some DPMs billing hundreds of new
patient level 4 (99204) office visits and
getting paid for them! How can that be when all
the billing seminars/billing gurus out there say
that this level of office visit is not even
billable by podiatrists?

Why is Medicare paying for these codes? It is
clear Medicare is not enforcing its own rules. I
hope some of the billing gurus out there will
chime in on this. Other DPMs bill almost all
level 3 office visits, few if any level 2
visits for both new and established patients.

Other examples include billing all 11042/11043
for wound debridements (no 97597s), all 11057
for callus trims (no 11055s), all 11721 for nail
debridements (few 11720s and certainly no
11719s). Some bill no nail/callus codes at all,
but instead bill hundreds and hundreds of office
visits, I assume so they can avoid the onerous
RFC rules that Medicare has instituted in an
effort to combat the fraud. The list could go on
and on. It is blatantly obvious who is doing
this upcoding and there is plenty of it
happening.

My guess is that Medicare doesn't have the
resources to go after all these fraudsters, and
that is why they are implementing the podiatry-
specific office visit codes. That will put an
end to the up-coding, at least for office
visits, and all us honest folks out there will
suffer the consequences too.

If Medicare was smart they would also make a
single nail/callus code to address that issue
too. I'm sure this kind of billing activity is
not just isolated to podiatry but wonder how
podiatry compares to other specialties in this
category? It seems podiatry may be singled out
for a reason. It is truly disheartening to see
this data and to hear stories of patients being
billed $2,000 for nail care, but not at all
surprising. I don't know how these individuals
sleep at night, but rest assured that honest
DPMs sleep just fine.

Name Withheld