Podiatry has a coverage problem that is unique in medicine. Routine foot care is excluded from Medicare coverage unless the patient has a qualifying systemic condition, and proving that requires specific documentation most notes do not contain.

The service was medically necessary. The chart just did not say so in the way the payer requires.

Q7, Q8, and Q9 report class A, B, and C findings that establish coverage for otherwise routine care. The findings have to be documented at the visit, by the provider, in specific terms. Appending the modifier without the underlying documentation is an audit exposure.

Diabetes with peripheral neuropathy, peripheral vascular disease, and related conditions can establish coverage, but the chart has to link the systemic condition to the foot care and often has to show the treating physician relationship and date of last visit.

Nail debridement and similar services carry frequency limits that vary by contractor. Billing outside the window generates a denial that is fully preventable with tracking.

Podiatric surgery carries the same global period complexity as any surgical specialty, with the added wrinkle that post operative routine care may or may not be separately billable depending on why it was performed.

• Charge entry and coding review against your documentation
• Claim submission and clearinghouse rejection management
• Denial classification by reason, source, and cause with actionable feedback to your team
• Accounts receivable follow up and payer escalation
• Payment posting and reconciliation
• Patient billing inquiries through our dedicated toll free line
• Monthly financial reporting so you can see what is actually happening

You keep your EHR and your workflow. We integrate with PrognoCIS, athenahealth, AdvancedMD, gGastro, Sevocity, eClinicalWorks, and Open Practice, among others.

Dr. Peter N. Brieloff, DPM, FACFAS, FACFAOM, described working with our team as wonderful, saying we do a great job and relieve the practice of managing billing.

His recommendation was to any group struggling with billing issues, which is generally how podiatry practices find us.

Cyndi Walker founded Medicus after decades inside medical billing, and holds Certified Medical Coder and Certified Healthcare Business Consultant credentials. Medicus carries corporate accreditation from HBMA and the National Society of Certified Healthcare Business Consultants.

We are not a call center and we do not route your account offshore. You get people who know your specialty and answer the phone.

Almost always documentation. Routine foot care is excluded unless a qualifying systemic condition is present and the record establishes it, including class findings and the treating physician relationship where required. The care was necessary. The note has to prove it.

Modifiers reporting class A, B, and C findings that establish coverage for otherwise routine foot care. They must reflect findings documented by the provider at that visit. Appending them without support is audit exposure, not a workaround.

By tracking them. Debridement and similar services carry contractor specific frequency windows, and billing outside them produces a denial that was entirely preventable. This is exactly the kind of thing a billing partner should be watching.

• Revenue Cycle Management
• Denial Management Services
• Chart Review and Clinical Audit Services
• Coding Education and Training
• Areas We Serve

Schedule a billing review and we will tell you where the revenue is going.