e/m w nail debridement or calus removal routine foot care

I am new to Podiatry and I am trying to understand when it appropriate to bill the E/M in addition to debridement or callus removal. Part of the issue is the providers seem to perform the same amount of work regardless of dx. A full bilateral foot exam will be done even though there are not any new complaints and they perform debridement, 11721.. 11055.. these include pre op E/M - global rules.
ex 1 est pt - Non diabetic or no other systemic condition but there is toe pain - full exam done and debridement - bill debridement only
ex 2 est pt - Diabetic controlled E11.9. Dx does not qualify but there is toe pain, no other complaints - full exam and debridement done. - bill debridement only ??
Ex 3 est pt - Diabetic w neuropathy E11.42 - last exam 60 days ago. no new complaints. full exam done and debridement - bill E/M? and debridement. Can you bill the E/M because they are assessing the effects that the DM may have w/ each visit? Is it medically necessary to perform a full exam on a systemic pt every 60 days or so?

Comments

  • I would consider each patient on a case to case basis. Uncontrolled or noncompliant diabetics need their feet examined much more frequently than a patient who has good management of their disease. I would be really careful of cookie cutter documentation and charging an e and m on all patients all the time.

    If you are a member of the APMA or other podiatric organization you may want to contact them. Some offer coding and documentation assistance.

    Beth

    Beth Aldridge, CPC

    Coding Manager



    Northern California Medical Associates, Inc

    Phone: (707) 573-6145

    Fax: (707) 573-6932



  • edited May 2017
    I agree 100% with Beth on this, I've been around podiatry a long time and her response is spot-on.

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219
    Tel: (941) 776-4822
    Fax: (240) 368-0059
    Web: www.hpmsi.com

  • I understand what you are saying. One question I have is if the pt is uncontrolled w neuropathy, is once per 60 days reasonable to perfrom a full E/M and if needed a debridement and bill both.

    Thank you
    Yvette Hofmeister, CPC
    614-685-2915 new #


  • edited May 2017
    That's a medical question I can't answer. The decision to perform and document medical care is the decision of the provider.

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219-0409
    Tel: (941) 776-4822
    Fax: (240) 368-0059
    Web: www.hpmsi.com

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