Last weekend the Washington State Podiatric Medical Association (WSPMA) and Washington State Podiatric Medical Assistants Association (WSPMAA) held their Annual Meeting in the Eastern Washington City of Spokane.  The site of this year's meeting was the recently-restored and very elegant Davenport Hotel, which inspired a more formal tone at the Awards Banquet, where we also indulged in Ballroom Dance lessons.  The WSPMAA elected new officers, including Lisa Crouch, President; Jamie Ancich, Vice President; Kelly Laswell, Treasurer; and Charity O'Connor as Secretary.  I was honored to be asked to serve again as Executive Director, a position which I held from 1994-1996.  Also on our Board of Directors this year will be Drs. Donald Hovancsek, Scott Schroeder and Tim Grace. 

The exhibit area surrounded one of the most beautiful spots in a hotel full of gilt and carving and impressive stained glass.  The facility was truly exquisite, and the programs were good, too! For a glimpse of the hotel and some of the seminar participants, visit Picture Pages 12-14 at this link:
http://www.footzine.com/FZ_8L.htm

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Since February of last year, FootZine subscribers have enjoyed the benefit of the coding wisdom of Dr. Phill Ward.  His increasing APMA commitments now mean that Dr. Ward cannot continue as a regular FootZine contributor.  While we will certainly miss his presence on the FootZine pages and the excellent information he has provided, we wish him all the best as he contributes even more to APMA.  Dr. Ward has sent one more article, a Top-Ten List, which he describes as his going-away present to us.  Thanks for everything, Phill!

As luck would have it, last weekend's Washington State meeting provided me with an opportunity to speak with Drs. Richard Horsman and Scott Schroeder, who have both agreed to provide input on your coding questions.  Dr. Horsman is an Expert Panelist for Codingline.com, and is also the Editor of CodinglinePRINT.  Dr. Schroeder has chaired the WSPMA Insurance Committee for several years.  I have heard both of these doctors lecture  -  or more accurately, explain  -  about insurance and coding many times over the years, and I know that their answers will be understandable, candid, and of course, correct.  Thanks to both of them for agreeing to join the FootZine cast!

  ~ Gayle

From:  Monica Thomas
re:      Podiatric Assisting Books

Dear Gayle,

I'm having a very difficult time locating the Podiatric Medical Assisting book at the local bookstores here in Guam as well as online.  Since this book is so popular, could you please tell me where I can purchase this particular book?  Is it out of print?  Is there another excellent book in its place?  Or is there another edition coming out soon?

Thanks for your help,
Monica Thomas
Guam

Hi again Gayle,
Thank you for answering my response so quickly.  I'd already have The Comprehensive Guide to Podiatric Medical Assisting book from years ago.  Unfortunately, no bookstore here (new and used) carries Podiatric Medical Assisting book here in Guam.  Also, I'd searched all of the online bookstores as well.  So far, this book has been out of print for the past six years.
If there's a new edition to the PMA book coming out, please let me know.

Thanks,
Monica

*_* Editor's Note *_*

I will certainly let everyone know whenever I hear that a new book is available.  In the meantime, some of the doctors' books can be helpful for more in-depth study of specific subjects, like anatomy, terminology, and radiology.  The instrument catalogs, such as from Universal Footcare Products, also have very good illustrations of many podiatric instruments.  If any of our subscribers has an extra/unused copy of one of the podiatric assisting texts, let me know and we'll share that information.

  ~ Gayle

*_*    *_*    *_*

From:  Marcia Urbana
re:      DMERC Refunds

I'm wondering if anyone has had experience with refunding DMEPOS  (Medicare DMERC for Illinois) for diabetic shoes that patients have returned AFTER DMEPOS and their secondary paid for them. Thanks for your help!

Marcia
Illinois

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From:  Howard Dinowitz, DPM
re:       New Jersey-Area Gathering

Howard Dinowitz D.P.M. here.
Looking to arrange a genuine,good ol' fashioned "BS" meeting.  Not to step on any other dates previously arranged by the AAPPM, Or to put it on a weekend that might conflict with a major APMA function.

I'm here in central New Jersey and would like to set up an informal, shoot the breeze, share ideas of practice management, coding,dispensing, and anything that comes to mind. 
Perhaps meet at the Carnegie deli in New York City and talk about Podiatry over hot pastrami and sizzling onion rings.  Something easy, no pressure, good food.  Some laughs and pick each others' brains for mutual benefit and comradery.

Feel free to call me, Howard Dinowitz (718) 627-1212
e-mail tenfeetz@aol.com

Looking forward, stay well

Howard

10. Incorrect insurance company billed
   * Copy insurance card front and back
   * Identify where to send the claim
   * Separate CPT from DMERC for Medicare
   * Does the staff know which plans you participate in

9. Inappropriate use of modifiers
  * Use digital and class findings modifiers
  * Use with E/M visit -25, -57
  * Use during global days -24, -58, -76, -78, -79
  * Use with multiple procedures -51, -59

8. Not using CCI correctly
  * Use the CCI
  * Do procedures on different visits
  * Follow list of codes in Federal Register

7. Misunderstanding health plans medical policies
  * Use the LMRPs for Medicare
  * Commercial carriers - some states have a law that states the carrier must disclose their policies to all providers upon request
  * X-rays - are you registered to take radiographs for that insurance company

6. Poor coding technique - CPT and ICD-9 do not agree
  * Doctors get to know your codes
  * Primary ICD-9 must match the CPT code
  * Superbill interpretation - did you code for what was done

5. Data entry errors
  * Garbage in garbage out
  * Train data entry people vigilantly
  * Each demographic/registration form is a potential $100 bill make sure the necessary info is there
  * Get spouse information when possible
  * Ask for insurance card every visit to check for any changes

4. Inappropriate bundling by health plan claim processing software
  * Appeal with CCI data

3. Not using clinical knowledge to assist in the coding and billing process
  * Have physician help with any clinical aspects or questions on appeals

2. Missing data on the claim form
  * Missing demographics
  * Missing referring doctor UPIN #
  * Missing referral authorization #
  * Missing (to and from date) hospital inpatient/outpatient data

1. Insurance companies are just stingy bastards
  * They deny for a reason
  * They live and make their money on the float
  * Their hope is that you will not appeal the claim in a timely manner so they win
  * They win: they keep your money
  * How we win: we learn their game and play it better than they do!

Crystal-Clear Coding tips by Dr. Ward are posted on the FootZine web site on this page:
http://www.footzine.com/FZ_C.htm

The Question:

Hi Gayle,

Here is my question.  What L code do other offices use for a lower leg walker that doesn't have gel in it and isn't pneumatic?  We use the Equalizer by Royce and we have used the Body Armor Boot by Darco.  For both we used L2112.  Any help would be appreciated.

Thanks,

Jenny Gilliland

The Answers:

Rick Horsman, DPM:

CPT /HCPCS offers two codes:
L4360 Pneumatic walking brace.... they don't care if it's hinged or not, or gel-padded or not. Medicare allowance is about $283.74.
L4386 NON-pneumatic walking brace.  Again, they don't care if it's hinged or not, or padded with gel or not.  Medicare allowance is about $127.20
L2112 is a prefab tibial fracture cast orthosis.  Fortunately, they did choose a "prefab" code (many offices try to use the custom made code, which is really fraudulent)... but this is NOT what these devices represent.
If in doubt, they should contact SADMERC, and get specific direction regarding appropriate coding for such devices.
I must state that manufacturer's reps are outrageously wrong in suggesting HCPCS codes.... But remember....if they are wrong, but you bill it that way.... YOU have a problem; NOT them.
The alternative is L2999, unlisted lower extremity orthosis.  The disadvantages of that code should be self-evident

Scott Schroeder, DPM:

In regards to Jenny's question about cast boots, the HCPCS code that best describes the boots she is using is L4386.

Coding Questions and answers will continue to be posted on the FootZine web site on this page:   http://www.footzine.com/FZ_C.htm

The first Coding Crystal I received from Phill Ward closed with this quote: 
"Knowledge is power." (from Sir Francis Bacon), and it is as true now as it was in 1597.  The more knowledge we can share with each other, whether via seminars or teleconferences or FootZine, the more effective we can be in our offices, and especially in our dealings with insurance companies.   I'm looking forward to hearing from you!

  ~ Gayle

Copyright 2004 Gayle S. Johnson. All Rights Reserved.
DISCLAIMER: Acceptance and publication of any letter, article, news item or advertisement does not necessarily constitute or imply approval or endorsement by myself of the product, idea, or content therein. I reserve the right to edit or to not publish any material received. Any letters published are the property of FootZine. Any health- or legal- and financial- related information is for educational purposes only and should not be construed as medical, legal or financial advice, or a substitute for the advice of a healthcare professional, attorney, financial advisor or any other consultant or professional. Information pertaining to legal matters should not perceived as legal advice, nor should discussion about such issues as Medicare, coding, and billing be considered as definitive. All content is presented as being only the opinions of the contributors and is for educational purposes only.

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