There are many complications in foot care coding for both CMS and other insurance carriers primarily due to medical necessity. CMS and many insurance carriers have very complex policies on foot care coverage. This session will sort out the policies and review medical necessity, a crucial part of offering these services, and determining who is responsible for foot care, insurance or patients.
Expert speaker Lynn Anderanin, CPC, CPC-I, COSC will take you through the policies available from CMS and some of the major insurance carriers in the country. ICD-9, ICD-10, and CPT® coding will be reviewed, as well as when it is necessary for the patient to pay for these services because the patient does not meet the criteria for coverage through their insurance carrier or Medicare. Lynn will discuss shoes, inserts, and other prescribed orthotics, along with a table for bunion repairs.
Irrespective of the specialty of the provider, foot care coding can be complex due to the medical necessity requirements both from Medicare, as well as commercial insurance carriers. Many insurance carriers will only reimburse for foot care services if performed to treat conditions of the foot, rather than preventative care because a patient may have a condition that affects the feet. For example, routine foot care for a diabetic patient with no foot symptom is not covered. Because of these reimbursement restrictions, diagnosis coding and CPT® coding is important to prove the medical necessity for patients with foot conditions, and to know when the patient is responsible for reimbursement. It is also important to understand what the insurance carriers consider appropriate for these conditions.
Who should attend:
Coders, administrators, auditors, collections staff, claims staff, billers, podiatrists, orthopedic surgeons, Internal medicine and family practice physicians.
Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, is the Sr. Director of Coding Education for Healthcare Information Services, a physicians revenue cycle management company. She has over 35 years experience in all areas of the physician practice, and specializes in Orthopaedics. Lynn is currently a workshop and audio presenter. She is a former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served...
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