Podiatry is a branch of medicine that focuses on the diagnosis and treatment of diseases, injuries, and deformities of the human foot. The diagnostic, medical, and surgical treatment of problems of the foot, ankle, and lower extremity are all part of podiatric medicine.
With a systemic ailment, CPT Code 11721 (Covered Nail Debridement 6 or More) requires a Q8 modifier (for routine check-up). Medicare will compensate you if this is medically required. However, this is only compensated six times per year.
T1 to T9 Modifiers are commonly used with podiatry codes (Toe modifiers). Toe modifiers are not utilised for CPT codes 97598, 11720, or 11721.
Toe modifiers are not utilised for CPT codes 97598, 11720, or 11721.
Injection operations (HCPCS code J3301) and J1100 (injection procedures) are often utilized in Podiatry Billing and generate a large amount of revenue to physicians.
For the respective description, use the CPTs listed below.
| CPT | Descriptions |
| 76881 | Ultrasound, extremity, nonvasculat, real-time with image documentation |
| 76882 | Limited ultrasound, extremity, non-vasculat, real-time with image documentation |
| 93922 | Non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral |
| 93926 | Duplex scan of lower extremity arteries or arterial bypass grafts |
| 20552 | Injections(s), single to multiple trigger point(s) on or two muscle(s) |
| 20553 | Injections(s), single to multiple trigger point(s) three or more muscle(s) |
| 20605 | Arthrocentesis, aspiration, and/or injections |
| 20610 | Arthrocentesis, aspiration, and/or injections |
| CPT | Descriptions |
| Physician Visits | |
| 99203-99204 | Office Visits New Patient (Level 3 – Level 4) |
| 99213-99214 | Office Visits Established Patient (Level 3 – Level 4) |
| Nail care & Nail Procedures | |
| 11720 | Toenail Trim (1 Foot) |
| 11721 | Toenail Trim (2 Foot) |
| 11730 | Toenail Removal |
| 11750 | Toenail Removal (Permanent) |
| 97597 | Debridement of Open Wound |
| 17110 | Wart or Lesion Removal up to 14 (benign) |
| Orthotics | |
| L3020 | Custom Orthotic Materials (OR002 |
| 29799 | Casting Impression Fitting (S0395) |
| 97760 | Orthotic Management Training 15 Minutes each |
| Other In-Office Procedures | |
| 29405 | Apply short leg cast (Non-weight Bearing) |
| Q4038 | Short leg cast material |
| 20550 | injection Tendon Sheath/Ligament |
| J3001 | Triamcinolone Acetonide (Typically 1 unit used) |
| DME | |
| L4360 | Otto bock Pneumatic Walker (immobilizing Boot (SS406) |
| L4396 | Foot Night Splint – Treatment for Plantar Fasciitis (SS397) |
| L1902 | Ankle Brace (SS243) |
Modifiers:
The findings relevant to the patient’s condition are indicated by Q modifiers. Billing for podiatric services is done using the codes Q7, Q8, and Q9.
With procedure codes 11055, 11056, 11057, 11719, 11720, 11721, or G0127, Q modifiers may be used.
| Modifiers | Descriptions |
| Q7 | One Class A Finding |
| Q8 | Two Class B Findings |
| Q9 | One Class B and Two Class C Findings |
Class A:
· Non-traumatic amputation of the foot or integral skeletal portion thereof
Class B:
· Absent posterior tibial pulse
· Absent dorsalis pedis pulse
· Advanced trophic changes (at least three of the following):
· Decrease or absence of hair growth
· Nail thickening
· Skin discoloration
· Thin and shiny skin texture
· Rubor or redness of the skin
Class C:
· Claudication
· Temperature changes (cold feet)
· Edema If multiple surgical procedures are performed, append payable modifiers must be used before class finding Q modifiers, or the ten-digit toe modifiers (TA-T9), or the left or right foot modifier (LT, RT)
Major requirements while billing podiatry services:
1. Inclusive CPT – CPT codes 11719, 11721 & G0127 should not be billed together to avoid inclusive denials
2. Frequency – Routine foot care services are considered medically necessary once in 60 days
3. Authorization – It is necessary to obtain prior authorization from the payer
4. POS – A common denial problem with durable medical equipment (DME) is listing inappropriate places of service
5. Insurance Verification – Podiatry claims get denied because of termination of coverage by the payer, the services provided are not being covered or the maximum benefit for Podiatry services has already been provided
For additional information, please contact us at +1440-209-5122 or [email protected]
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