FootZine Page 806

Being a long time in the making, this issue of FootZine is on the lengthy side. We have collected a number of coding questions, a job listing, a couple of Calendar entries, and several letters. Along the way I received some questions about charges for posting this information, and whether different levels (costs) of membership receive faster responses. Those new to the FootZine community may not realize that FootZine subscriptions, as well as the listings and information contained here, are free. The purpose of FootZine is still to provide an exchange of information and ideas that will help podiatric offices and their personnel in our chosen work.

It's not too soon for a reminder that the deadline for HIPAA-compliant Medicare claims is October 1, 2005. That's less than 2 months away, after which non-compliant claims will be rejected by CMS (including DMERC). CMS and its intermediaries do have inexpensive software and resources to help those who have not completed the transition to HIPAA claims compliance. More information is available at this CMS link:
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3956.pdf

~ Gayle

*_* Letters *_*

From: Dr. Rahul Gor
re:      Medical Billing Company

Hi,

I am looking for a Medical billing company that has a focus on processing
claims for Podiatrists. I am opening a practice in Laurel, MD. Would you
know of any reputable billing companies?

Dr. Rahul Gor
rgor@comcast.net
301-792-0292 (cell)
301-953-3555 (Phone)

*_*    *_*    *_*

From: Gail Bennett
re:      Reaching Medicare Appeals

Does anyone have a trick to get through to the Medicare appeals line? I have been trying for two days to get through and it keeps disconnecting me after I actually get through after many hours of redialing. It's quite frustration.

Thanks for any ideas you might have.

Gail B.
(509) 838-2929

*_*    *_*    *_*

From: Paul Rhoda
re:      "The Best"

Where would I find a list of the best podiatrists in New York City and Boston? Does a ranking or rating system exist?

Thank you,

Paul Rhoda

*_*    *_*    *_*

From: Mel J. Colon, DPM, FACFAS
re:      Employee Handbook

Hi Gayle,

I hope you are doing well.

I retired at a very young age and have recently come back to practice only treating the uninsured, multicultural community (mostly Hispanics and Koreans).

I am writing you to see if you have a copy of an employee handbook/rules/training, etc. that may be helpful in my managing my practice.

Mel J. Colon, DPM, FACFAS
International Medical Clinics
5979 Buford Highway,
International Plaza, Suite B-4
Doraville, Georgia 30340
www.intlmedicalclinics.com

drs4drs@yahoo.com
678-547-0000
678-522-2870 Direct
678-547-0191 Fax

*_*    *_*    *_*

From: Four-doctor Office
re:      Software Packages

Dear fellow practitioners:

We are purchasing new software for our four doctor office.
Would appreciate any prompt response to the packages listed below whether good or bad.
1) medisoft
2) DPM8000

We also looked at Sammy but felt it was much too expensive for our budget.

Please respond to mdhhrh@insightbb.com

Thank you.

*_* Editor's Note: This writer has asked for a direct response, but we think that other FootZine readers would appreciate being able to read your responses.   Please send a copy of your response to FootZine, too, so that we can share it. Thanks.   ~ Gayle *_*

*_*    *_*    *_*

From: Krista Alexander N.R.C.M.A.
re:      Upcoming Seminars

I am a Medical Assistant, working for a Podiatrist. Please email me information on upcoming seminars available in this area.

Thank You very much,

Krista Alexander N.R.C.M.A.
(my email is atsirk9@yahoo.com)

*_*    *_*    *_*

From: Lauren Simon Ostrow
re:      New Resource for PMAs

Gayle:

Please let your readers know about a new resource available to them on www.podiatryonline.com. This is a discussion list specifically for podiatric assistants to communicate directly with one another about topics of concern to them and their practices.

It's easy to use: Simply post your message, and mark the box that will notify you by email when someone replies to your message. You also can go to the site at any time to read other message threads or post a new topic.

I've copied the direct link below, but you can also get there from the Podiatry Online home page. I hope that the discussion forum proves to be a valuable resource to the PMA community.

http://www.podiatryonline.com/main.cfm?PG=board&FN=thread&cat=2

Lauren Simon Ostrow
www.podiatryonline.com
Email: podiatrynews@aol.com

*_* Calendar *_*

Hello,

Would it be possible to list our event in
your conference listing for free?

Date: 9-10 November 2005
Location: Ghent, Belgium
Title: Belgian Diabetic Foot Conference
Association: Vereniging van Gegradueerden in de
Podologie/Flemish Podiatry Association (VGP/FPA)
Conference URL: www.podologieweb.be/congres

Thank you, best regards,

Charlotte De Jonckheere
Deputy Chairman VGP/FPA

*_* *_* *_*

Attached is the flyer for our course [The Foot Care Connection© presents
The Basics & Beyond A Nursing Foot Care Course]. The brochure, with more details, will be ready soon. Feel free to forward flyers to anyone you think might be interested!

Sincerely,

Laura Roehrick RN, CFCN

FootZine's Calendar page is found at http://www.footzine.com/FZ_4.htm

*_* Networking *_*

Positions Available

Hi Gayle,

I am Podiatrist practicing in the Tampa Bay Are (Hudson), FL. I am looking for a Office Manager/Medical Assistant. 727-869-1782 .

Thanks,

Dr. Nimesh Patel

Notices of positions wanted or positions available, as well as other "classified" information, are welcome. They are posted at the FootZine web site's Networking page. Have a look at http://www.footzine.com/FZ_6.htm

*_*

"Success comes from being willing to learn new things, being able to assimilate new information quickly, and being able to get along with and work with people." - Sally Ride, Astronaut

*_*

*_* FootZine Feeture Article *_*

Crystal-Clear Coding Q & A
by Rick Horsman, DPM, and Scott Schroeder, DPM

The First Question:

Thanks for your service.
I have a provider who wants to use L3020 code, what would be the appropriate fee to charge an insurance company for this code?

What about L4210?

Dayna Coats

The First Answer:

For L3020, the provider's fees for orthotics would apply as long as casts were taken and the orthotics fabricated off of the casts. For repair of an orthotic L4210 this is all going to depend on what was done and what the provider feels it is worth. These are difficult fees to come up with for all of us. Usually we end up under-billing for the time spent on repairs for us and our staff. We typically do this as a partial courtesy to our patients.

Scott Schroeder, DPM
Wenatchee, WA

Another First Answer:

When I first started in practice almost 30 years ago, there were no "fee schedules". You had no guidance on what to charge for nail care, or a neuroma excision, or a bunionectomy, or anything else. When you're first starting out, you REALLY have no idea.

The California RVS ("CRVS") was the first publication I ever saw which listed a numerical weighted value of all services and procedures. It was considered "price fixing" (and therefore illegal) in most parts of the country.

With RBRVS, the relative weighted value of all listed services is there as public record. You may feel some are overvalued, and some undervalued, but at least there is some published agreed-upon standard.

The problem comes in with the codes you describe, as they do not have an RBRS value. They are essentially "by report". You must look at your own expenses (both fixed and variable; tangible and intangible), to the best you can calculate them, and come up with a fee which you feel is reasonable. There will be no guidance from the carrier. They are hoping that you will "low-ball" the fee, and charge less than what their internal computer files have calculated as an industry average. Similarly, you don't to go way over the mark, as you come across as a money-grubbing scoundrel.

That's how it's supposed to work- the system is not perfect, by any means

FYI L3020 is per orthosis- NOT per pair. Presumably, the fee for repair of an orthosis would also be per orthosis, not per pair.

Rick Horsman, DPM
Olympia, WA

The Second Question:

Gayle,

We have started doing punch biopsies here in the office. I am not sure how to bill for them. Can you help me?

Thanks,
Cindy Bryce, PMA
for Dr. Roy Corbin
Bangor, Me

The Second Answer:

CPT 11100 (Biopsy, one lesion) is the correct code. It includes any anesthesia and closure, if necessary.

Use CPT 11101 for each additional lesion biopsied. CPT 11101 is an "add-on" code, and must not be used without also billing CPT 11100.

Rick Horsman, DPM

The Third Question:

With wart destruction or incision and drainage there is a 10-day global period (17110). Is it appropriate to use a 58 modifier if the doctor wishes to treat the patient within the 10 days global?

-58 modifier reads: "staged or related surgical procedure"

"Use this modifier if there is a need to indicate that the performance of a procedure or therapy in the post op period was pre-planned. Use the modifier on the staged or related procedure. Do not use this modifier for the return to the operating room. -78 should be used in that situation."

Gail Bennett
Office of Ronald J. Douglas, DPM

The Third Answer:

"Global" means "global".

For Medicare, these codes have a 10-day global period. If you are seeing the patient for follow-up regarding the same problem and its management, you do not charge separately.

I have trouble perceiving any indication for a true staged procedure with these codes. I certainly cannot think of any pre-planned reason for follow-up other than a quick "look over" to ensure everything is ok.

If the global period were 0 days, the allowance for the code would be less; not the same.

But remember, other payers may not have a 10 day global.... you won't know if you don't ask.

Rick Horsman, DPM

The Fourth Question:

Gayle,

Hope all is going well. Have an example questions!

Example: 5 lesions to be removed. Would you bill 17000 and 17003 OR 17000 and 17003 x 4. There seems to be ongoing confusion and would like to get this straight in our minds once and for all.

Jenny Wood for
Associates in Podiatry

The Fourth Answer:

17003 is an "add-on" code. It should not be used without 17000.

17000 is billed once for the first lesion.

17003 is billed as many times/units as you treat additional lesions..up to 14

So, for treating 4 lesions:
17000
17003 (three units)

If treating 15 or more, you ONLY bill 17004. 17000 and 17003 are no longer applicable.

Rick Horsman, DPM

The Fifth Question:

Gayle,

Would you please explain to me how these can and cannot be used in a podiatry setting.

We gave been told that 10080 is not an allowable code with Medicare. Any other one we could use?

Thanks for your help!

Jenny Wood
Executive Vice President
Wood Medical Billing Medical Professional Resources

The Sixth Question:

Hi Gayle,
As per your advice, I visit FZ site often. It has
helped me learn a lot. But I need more help in
understanding the appropriate use of modifiers:
1. For Bilateral procedures, ins. either denies or pays
half on the second procedure. Certain procedures like 20550,
11750 do not qualify for modifier -50 so we billed them with
RT/LT modifier or T modifier but still got rejected. 11750 was
done on both lateral and medial borders so we added modifier
-51 for multiple procedures (with unit of service 2) but that
caused confusion too.
2. Similarly for bunion surgery(28113 rt/lt) do we need
to use any modifier?
3. for orthosis (L codes), do we need a modifier to get
paid since that is always bilateral?

Please advice.
Regards,
SG

The Seventh Question:

This is my first time accessing your web site. I am needing any coding information possible in regards to the trimming of corns or callosities (11055 11057) when billing Medicare Part B in the state of Tennessee.

Is it covered under any circumstances, and how to bill?

Your help will be greatly appreciated.

Caryl McCartt

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

*_*

"Ah, summer, what power you have to make us suffer and like it." - Russel Baker

*_*

We're all feeling the heat these days, and it seems sometimes that slow-motion is the best speed we can muster. If you find it too hot outside to do anything else, how about a quick note to FootZine? We look forward to hearing from you!

~ Gayle