Successful Podiatry Practice Management Codes

SUCCESSFUL PODIATRY PRACTICE MANAGEMENT CODES

PLEASE DON’T DISCLOSE THE DATA IN THIS FILE TO THOSE WHO DID NOT PURCHASE OUR PROGRAM. WE FEEL IT IS YOUR SPECIAL PRIVILEGE TO INCREASE YOUR INCOME. WE APPRECIATE YOUR BUYING OUR PROGRAMS. THIS IS OUR GIFT TO YOU. LIKE ALL EXCELLENT GIFTS, IT WILL KEEP ON GIVING.

The information contained in this file can increase your yearly income substantially if you read it and start doing them. Most can be done without ambulatory surgical center accreditation, in your office or even in a nursing home if the patient has adequate circulation.

Over the years, we have learned what creates successful practices. Mostly it’s knowledge of the right procedure codes to use and is surprisingly simple. Great success in practice is usually accomplished on a narrow margin. It is shocking how simple that this success can be obtained, since it is entirely based upon your knowledge.

GO TO SEMINARS AND LEARN NEW PROCEDURES. THEY WILL MAKE YOU MONEY

READ THE LITERATURE TO LEARN WHAT OTHERS ARE DOING FOR THE CONDITIONS YOU SEE EVERY DAY. THERE IS A REASON WHY THEY ARE SUCCESSFUL. ALL YOU HAVE TO DO IS WHAT THEY ARE DOING.

USE OUR PROGRAM TO EVALUATE AND PRINT YOUR ROUTINE FOOT CARE REPORTS.

CONSTANTLY LOOK AT THE CPT AND LOOK AT WHAT CREATES HIGHER FEES. OFTEN THEY ARE SIMPLE PROCEDURES THAT YOU CAN LEARN TO DO.

DOCUMENT YOUR X-RAY REPORTS WHEN YOU READ X-RAYS. INSURANCE AUDITORS WILL LOOK FOR THEM. IF THEY DON’T FIND THEM, THEY WILL DEMAND MONEY BACK, PERHAPS A LOT.

READ THIS ENTIRE FILE. IT IS FILLED WITH PRACTICE MANAGEMENT HINTS THAT COULD MAKE YOU A LOT OF MONEY THIS YEAR.

I. IMPLANT ARTHROPLASTY:

For those with a certified ASC, there are huge income opportunities for this code. Even without it, you can tremendously increase your income for the average hammertoe operation, and still get payment for the implant. If you have an ASC, NEVER bill the implant code on the ASC bill, this will always be rejected. Always bill it on the surgery bill itself.

The hammertoe operation has been done by podiatrists almost every since we first existed. All you have to do is to add a simple implant to make a lot more money for everyone that you do. Here’s the data:

This is a very simple technical procedure that utilizes a Shannon 44 bur to ream out the stub of the proximal phalanx and the intermediate phalanx. After this, a SHAW-SHIP ROD is installed. The implant is very small and flexible, and it helps keep length and maintains shape. They come in varying “stiffness” They can be easily cut to fit any need, for both proximal and distal Interphalangeal joints for toes 2-5.

They are available at Sgarlato Laboratories, (800) 421-5303. Go to this website to learn more about them: http://www.sgarlatolabs.com/shawrod.htm

The exact amount you can bill for Medicare depends on your location in the U.S. You can look up fees in your State and County on this URL: Then select “ONLINE TOOLS” http://www.medicalmanagement.com/

CODING INFORMATION:

Procedure code ASC Code Supply Code

26536 Implant Arthroplasty 26536-SG (category 5) L-8658 (A hand code)

$622.06 717.00 350 (billed to M’care)

Don’t forget: Even though you may not have an ASC you can still bill for the supply code for the implant. In fact, you cannot bill it under the ASC designation, you must bill it under the “office and surgical” designation.

Medicare pays the above rates in most counties. Some “rural” counties they pay a little less. The implant costs 165 dollars, but Medicare will reimburse you about 325 dollars. Naturally, if you do several on the same patient, you get 50% on the remaining procedures, but it is my understanding that you still get the same amount for (each) implant.

Considering the time, simplicity and general need for hammertoe surgeries, this is probably the most powerful income producer known for a podiatric ASC. Those with an accredited ASC can charge facility fees for their patients’ use of the operating room. If you have any desire to get certified and want to learn more about it, do check our web site: http://officeascaccreditation.homstead.com/

We sell a Manual System to help you get certified. As you start to earn more money using the information in this file, you might start thinking more about it. The fact that you don’t necessarily do “large” procedures makes you perfectly suited for an ASC. Most of the time, ASC owners do routine, simple podiatric procedures in their ASC, which take the least time, expose them to the least malpractice risk and make excellent fees.

II. INJECTION OF NEUROMAS WITH DILUTED ABSOLUTE ALCOHOL, betamethasone and local anesthetic.

You must be very careful to clearly mark and put a piece of tape on the solution vial so as not to accidentally inject it for a nerve block.

The procedure is repeated periodically over several weeks of treatment. Be sure you explain the cost to the patient, even if their insurance company will pay for it (which it universally does).

Procedure code: 64640 Chemical Neurolysis, distal nerve

Medicare pays $249. 68 for each injection. You can use a HCPIC code of J-0702, and charge an additional 30 dollars. Medicare will not pay the entire 30 dollars, but most privates will.

If you give a posterior tibial nerve block (before) the neurolysis, you can also charge 64450, but be sure to use the –59 modifier for the second injection. If you feel that those fees are too high, you can “bundle’ the PT block into the neurolysis.

Tarsal coalition and subtalar pain. This is often helped by sclerosing solution injections as an important to try conservative treatment prior to surgery. These procedures are “large” surgeries and it is important to have tried at least several conservative choices including orthotics and injection therapy prior to going into it. They pay extremely well and reduce your exposure to large procedure surgery malpractice risk.

III. . INJECTION OF PLANTAR KERATOMAS WITH CYSTIC STRUCTURES UNDER THEM THAT CAUSE PAIN

Use the above procedure codes to inject the plantar nerves under an intractable plantar keratoma. Most plantar keratomas have an inflamed nerve under them that you inject. Often this gets rid of the keratoma itself, or reduces it substantially.

You can read more about this procedure by reviewing this excellent article in PODIATRY TODAY: When Injection Therapy can Relieve Painful Lesions, Gary L. Dockery, DPM June 2002. Their web site is: http://www.podiatrytoday.com/podtd/displayTOC.cfm?issueID=archive/currentIssue24- May-2002-06-54-22

There is a small subscription fee to obtain this article. You should read everything in PODIATRY TODAY anyway.

IV WOUND CARE AND DIABETIC WOUND CARE

Surgical and non-surgical treatment of diabetic ulcers and wound care represent an excellent opportunity for income. You need to look on the Internet to find methods to use to expand your practice. If you have nursing home patients with ulcers and wounds, this represents an excellent income opportunity. You can start by referring to this excellent internet article: http://endoflifecare.tripod.com/imbeddedlinks/id3.html

You might be “walking past” excellent opportunities for treatment and coding. Since these conditions tend to be chronic, this also represents an extended treatment opportunity that is almost always covered by Medicare, since it is not in the “routine foot care” exclusion list.

You need to be prepared for your next ulcer. Do you have an appropriate format set up for treatment? Do you have written forms you can put in the patients’ nursing home charts containing orders, etc? Do you have the treatment codes prepared?

V. X-RAY AND INJECTION TENOGRAMS IN THE OFFICE

Codes for billing of x-rays for tenograms and the injectable material exist

Many people with heel pain that radiates proximally up the lateral aspect may have a concomitant tendon inflammation of the peroneal structures, even a tear. It is not unusual for this to happen and frequently can be a cause of treatment failure unless detected.

Many people who “cross their legs” experience painful lateral peroneal pain as well.

SUMMARY: A surgical center will drastically improve your income and reduce your malpractice risk when combined with these and other codes. They are effective and pay very well. Rather than decreasing the reimbursements for some of these, insurers have actually increased them.

When combined with a Medicare Certified Surgical Center, these and other procedures combine to allow podiatrists to match or even exceed the income of orthopedic surgeons. This is accomplished without doing extensive, risky and complex podiatric procedures.

It is our experience that knowledge is power. The line between doing extremely well and much less so is only the difference between a few codes and the frequent repetition of those in daily practice.