FootZine Page 807

Three years have sped past since the first issue of FootZine. In that time, we have seen the subscriber list increase to nearly 600, including podiatrists and podiatric assistants, nurses, students, billers, suppliers and other interested parties. FootZine was created to provide a resource for communication between podiatric offices, giving us a way to share information that will help us in our office lives. I'm happy to say that the concept seems to be working very well.

The FootZine web site, at www.FootZine.com, stores all of the coding, HIPAA, practice management and other articles and columns that have appeared in FootZine. There is also an Archive of all past issues of FootZine, and a search feature to access information contained in the web site and previous broadcasts. The Networking and Calendar pages are ever-changing as positions are found/filled, equipment bought/sold, and seminars come/go.

Many thanks to Drs. Rick Horsman and Scott Schroeder, who have been kept especially busy with coding questions in recent months, and to the other regular contributors to FootZine.
Thanks to the subscribers who encouraged me to begin this publication and have stayed with us through the technical ups and downs, and have been patient when real life interfered with the publishing schedule.

I want to express my appreciation again to Barry, John, Lynn, Marlene, Deb, Ann, Hal, Ray, Heather, Tom, and Alison, the FootZine Advisory Board, who are always there, if often behind the scenes, with their valuable insights and ideas.

Thanks again to Ray Posa of R. Francis Associates for continuing to provide FootZine with its domain and internet home. And to my husband, Michael, for making sure everything works.

~ Gayle

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"Do not go where the path may lead, go where there is no path and leave a trail." -
Ralph Waldo Emerson

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*_* Letters *_*

From: Lynn Homisak, PRT
re:      Employee Handbook (Volume 107)

Dr. Colon,

If you are interested in a custom-crafted office manual, please contact me at Lynn@soshms.com. Through confidential telephone consultations with you, we will obtain specific information for your individual practice which we will then use to produce a completely customized practice manual featuring your practice policies, procedures and practice forms. Even your practice logo will be included. You can obtain more information about this unique service on our website at www.soshms.com under "products." If you have any questions regarding this, I will be happy to address them with you.

Thank you,

Lynn Homisak, PRT
SOS Healthcare Management Solutions, LLC
www.soshms.com

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From: Debbie McGovern
re:      Software Packages (Volume 107)

Gayle,

Regarding a question asked on FootZine. When choosing a medical program for our office we chose Medisoft. The program is very easy to use and after 2 years we are pleased with it. The training CDs are extremely helpful and worth the cost. We want to warn others however, that the service for the software is less than desirable. Wait time for help is a minimum of one hour. The technical staff has difficulty relating to the customer who may not understand the technology. We chose the package rather than just the software which included a six month service. In that time we were able to learn enough so that we have not had to use their support service since.

Still learning a lot from FootZine. Thank you for your efforts.

Debbie McGovern, Office Manager

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From: Gail Bennett
re:      Software Packages (Volume 107)

I use Medisoft and have for many years. While it is limited and I do wish it did things that it doesn't, for the price I feel it works quite well. The biggest problem I have noticed is getting reliable backup support. We use Focus Medical in Spokane, WA but have heard others who have also used Focus and were NOT happy with them. If I can help you with any Medisoft questions please feel free to contact me.

Gail Bennett
with
Dr. Ronald J. Douglas
(509) 838-2929
Gailbpmac@aol.com

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From: Jenny Gilliland
re:      Diabetic Shoes

Hello again Gayle,

I have a question to pose.

How can DME suppliers (ie: people who come in to town and set up at Motels) guarantee that everyone qualifies for diabetic shoes as they advertise?

We do an evaluation to determine if a diabetic patient qualifies for diabetic shoes. How can other suppliers dispense shoes without a professional evaluation of their feet?

Thanks for your help!

Jenny G.
Tennessee

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From: Joyce Berman
re:      Seminars for Assistants in Pennsylvania

Hi. I have a question for FootZine. I am an inactive member now living in PA with PMAC certification. I need a seminar between October and April (I think that's when we renew) to keep my certification. Are there any seminars coming up in the Pennsylvania (or surrounding states) during those months? Thanks for the help and for the ezines.

Joyce Berman

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From: Bob M.
re:      Squeaky Orthotics

All powder has done for my prescription orthotics is create a fragrant cloud just at [the back] of my heels. The squeak remains.

Bob M.

*_* Editor's note: Can anyone offer some good ideas to Bob about eliminating the squeak in his orthotics? *_*

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From: Joanne Fallon
re:      Scrubs

Do you know of any company that makes scrubs especially for podiatry offices?

Joanne Fallon

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From: Charity O'Connor
re:       WSPMAA Update

Hi all!

With summer coming to an end and fall creeping in, I’m sure you’re all looking   forward to our   upcoming seminar as much as I am. I have been hard at work trying to find new topics to present based on your suggestions. Here are a few of the topics that will be presented at the fall seminar, October 15th at Providence [Colby Campus Professional Building] in Everett, WA: *Presenting a Professional Image, *Sterilization Techniques, and *First Aid training in the afternoon. It’ll be a day packed full of great information, and we are excited to see you all there. Please don’t forget to fill out the registration form and return it promptly. Lunch will be provided, and we’ll need an accurate head count to make sure everyone is fed!

Aside from the fall seminar, I have also been working on putting together a few AIDS classes. There were not enough people that responded to schedule a class. I will send out another inquiry later this fall. For those of you who did respond, I will be in contact with you and give you some resources to take the class sooner.

It’s been a busy few months, but I enjoy seeing things come together nicely. See you all soon!

Charity O'Connor
Vice President, WSPMAA

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From: Susan Scanlan, DPM
re:      WSPMA Nurse Footcare Course

Whew, that was a big issue! Hi, can I give you a link to our nurse class for an ad? [See below - Editor]

Susan Scanlan DPM
Executive Director WSPMA/Region VII

*_* Calendar *_*

WSPMAA Fall 2005 Seminar
October 15, 2005
8:30 AM - 5:00 PM
Cascade Room of the Professional Building at
Providence Everett Medical Center/Colby Campus
1321 Colby Avenue
Everett, WA
425-261-2000

For more information contact: Charity O'Connor, CPC
Vice President, WSPMAA
Charitywa@yahoo.com

For map or directions go to:
http://maps.google.com/maps?oi=map&q=1321+Colby+Ave,+Everett,+WA

*_* *_* *_*

WSPMA Nurse Footcare Course
WHEN: November 11 & 12, 2005
TIMES: 8:00AM to 5:00PM
WHERE: Auditorium at Swedish Hospital, Providence Campus, Seattle, Washington
CONTACT: Susan Scanlan, DPM, via e-mail link or (866)343-6999
DIRECTIONS: Search for Swedish Hospital, Providence Center Directions
COST: $150

Contact: http://www.wspma.org/wspma/nursefootcare.html

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

*_* Networking *_*

Positions Available

PODIATRIC OFFICE ASSISTANT needed for a growing urban practice under new ownership in the Seattle area. Must be able to work with a diverse clientele. Must also be interested in expanding and marketing the practice. Looking for a positive, energetic person who is able to abide by practice policies and procedures and loves to see new growth. Inquire at Phone: 425-644-7696, Fax: 425-644-7692.

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Dear Gayle:

I am looking for a podiatric medical assistant. Front office skills would be helpful also. My practice is located in Auburn Hills, Michigan.
Please call 248-377-0033.

Harold Koehler
hmkdpm@comcast.net

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Greetings,

My name is Akilah McRoy and I have been a Registered Nurse for the past 19 years. Additionally I am also a Licensed Nail Technician. I have extensive experience as an agency administrator, clinical supervisor, case management and most recently wound care manager for a long term acute care facility. I would now like to explore opportunities as a freelance assistance for podiatrist to assist with follow up care for your home bound clients. I am located in the southern California Los Angeles area. I would be very happy to meet with any podiatrist in Los Angeles County area to further explain how I can be an asset to you and your clients. Please feel free to notify me at (310) 722-4046.

Akilah McRoy,RN/Licensed Nail Tech

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

*_* FootZine Feeture Article *_*

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

The First Question (from Volume 107):

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 First Answer:

10080 is incision and drainage of a Pilonidal cyst. I would recommend using 10060- incision and drainage of abscess. In the CPT book you will see that this includes essentially everything we see in Podiatry that needs to be I&D'd.

Scott Schroeder, DPM
Wenatchee, WA

The Second Question (from Volume 107):

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 Second Answer:

Bilateral procedures typically pay half for the second procedure. Different insurance companies may handle these differently on how they want you to bill them to get paid. I would recommend calling your provider representative from the particular insurance company you are having problems with and ask them directly how to get paid for work your doctor has done. If you want to play darts and just keep taking stabs at it to see if you get paid you can try the following: If the right and left, and T modifiers are not working try the -59 modifier which means different site. We use this on our multiple surgical procedures and have had very few problems. This holds true for injection codes too. L codes such as L3030 or L3000 are per "each" foot. They should be billed with a right and left modifier and never be billed as a "pair". Example- if your price for a pair of orthotic devices is $250 you would bill L3000-RT for $125 and L3000-LT for $125.

Scott Schroeder, DPM

The Third Question (from Volume 107):

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

The Third Answer:

For the Fine State of Tennessee I would recommend you contact your Medicare provider representative (yes- they are supposed to have them everywhere but many offices do not know they exist) Contact your regional Medicare carrier and ask for a provider representative for Podiatry. If they don't have one specifically for Podiatry they should be able to get you to someone who can help. Ask for the routine foot care policies relating to 11055, 11056 and 11057. They should be able to get you to the information whether it be on-line or they can send you something. Most likely on-line these days.

In the state of Washington these are covered services and we bill the codes the following way: For one callous on a patient who is "at risk" [DP and PT pulses non-palpable- or DP or PT pulse non-palpable and three other findings indicating trophic changes (thin skin, decreased hair, thickened nails, etc)we would bill 11055- Q8 with a Dx of 700 (callous) and 443.9 (unspecified peripheral vascular disease). If two-four callouses you would use the 11056 and five or greater 11057. There are other ways of billing it in our state with different secondary diagnosis depending on various "at risk" conditions and the policy is quite lengthy but that is the gist of it. I do not know if the same policies hold true for Tennessee but your local rep should be able to help you with that.

Scott Schroeder, DPM

The Fourth Question:

Hi Gayle,

I was wondering if you can offer any help on how we can get Medicare to reimburse us for Code A4590, special casting material. We have used it with these diagnoses and have been denied - primary, 729.5, secondary, 825.25, tertiary, 707.14. Any help would be appreciated.

Thanks,

Mary Triolo
Alvarado Podiatry Center

The Fourth Answer:

The appropriate code for cast supplies for Medicare are as follows:
Q4037- cast supplies-short leg cast-plaster-adult(11+ years)
Q4038-cast supplies-short leg cast-fiberglass-adult
Q4039-cast supplies-short leg-plaster-pediatric
Q4040-cast supplies-short leg cast-fiberglass-pediatric

This includes all rolls of plaster or fiberglass and padding per cast.

Scott Schroeder, DPM

Another Fourth Answer:

A few years ago, Medicare (in their wisdom?) developed a series of 52 cast supply codes, to replace the 2 that had been used (including A4590). For Medicare, each of these Q codes was specific for a type of cast and age of the patient. Scott is quite correct

I think Medicare thought everyone else would think this was a great idea.... but no one else has followed. A recent Federal Register would seem to imply that Medicare will be moving away from their stance (and going back to A4590, etc.? I doubt it).

Rick Horsman, DPM
Olympia, WA

The Fifth Question:

If we do a partial debridement of a wound in the office and code a 11040 and then send out for a wound culture, isn't there something else we are supposed to be billing for other then the 11040 and the 99213-25? Maybe specimen handling?

We are simply sending out the culture to a laboratory and awaiting results, but I thought perhaps we were supposed to be able to charge for the specimen handling here?

The other question I have is that if this is during his global post-operative period, I can still bill that, but I need the modifier 79 right, or is it considered related because of the diagnosis 998.32 wound dehiscence?

Really curious,

Kelly
South Portland, ME

The Fifth Answer:

There are several components to the question, but the very first important parameter is whether this is a Medicare patient.

If so, any management of complications that does not require a return to the OR is included in the global allowance. So, evaluation and management of a wound dehiscence, culture, debridement, antibiotics, etc is all included in the global allowance-- for a Medicare patient. If these services are performed in the hospital OR or OSC, they can be billed with a modifier, reflecting a staged and related procedure. Otherwise, they're free.

P.S.: Medically necessary and documented x-rays are billable.

For a non-Medicare patient, you can bill for both the E/M and debridement. You really should not bill for the specimen handling (it pays about $3 anyway). If the problem is wound dehiscence, you may have problems billing for these services after a prior surgery. A diagnosis of cellulitis may be more favorably considered.

Not every payer will reimburse for these services, so you might be wise to contact the payer in question, advise them of the problems the patient is having, and what you intend to do (and charge for....), and get some guidance from them

What you DON'T want is to provide a surgical procedure to a patient, have a wound complication (which may or may not be considered "the doctor's fault"), and then hammer the patient with charges for non-covered post op services.

Rick Horsman, DPM

Another Fifth Answer:

A follow up on this question-

If this is a diabetic or other type wound that required debridement in the O.R. (I&D, or debridement) and the doctor knew at that time that this wound would likely require further debridement or wound closure then this can be documented at the time of surgery and further debridement codes and wound closure codes should be covered with -58 modifiers (staged procedure during post-operative period). This holds true even if all the procedure codes have global periods. If the physician performs a debridement in the operating room of a wound into subcutaneous tissue (11042) which has no global period and the patient is treated as an in-patient or out-patient, these visits should be charged for. If the procedure was an I&D (10060-10061) or a 11043/11044 then a 10 day global applies and an office visit or hospital visit would not be able to be billed. However, if further debridement was performed at bedside or in the office then the appropriate debridement code (11040-11044) with a -58 modifier should apply and be paid. Please make sure your physician documents at the time of original debridement or I&D that further would care will most likely be needed.

Scott Schroeder, DPM

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

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"The great accomplishments of people have resulted from the transmission of ideas and enthusiasm." - Thomas J. Watson

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"Real life" has made us slow sometimes this year, but hasn't diminished our appreciation for your participation in the FootZine community. We look forward to your letters, questions, and ideas.

~ Gayle