A Practical Guide to Podiatry Billing and Coding with Real CPT Cases
Medical billing and coding in podiatry requires specialized knowledge to ensure accurate insurance claims, proper reimbursement, and compliance with regulations. This guide provides actionable insights for podiatry billing professionals, highlighting workflows, key CPT codes, modifiers, and common challenges.
What Makes Podiatry Billing Unique?
- Specialized CPT codes: Foot and ankle procedures.
- Frequent use of modifiers: Laterality and procedural nuances.
- Insurance considerations: Medicare, Medicaid, and commercial insurers.
- Pediatric billing nuances: Growth and developmental ICD-10 codes.
A Complete Podiatry Billing Workflow
| Step | Phase | Action Details |
|---|---|---|
| 01 | Insurance Verification | Verify coverage for foot, ankle, and pediatric procedures. Check for prior authorizations. |
| 02 | Clinical Documentation | Create accurate documentation using SOAP Notes. |
| 03 | CPT Coding | Map procedures to CPT codes using official descriptors. |
| 04 | ICD-10 Diagnosis | Apply codes (E11.621, M20.11). |
| 05 | Modifier Application | Use -RT/-LT, -59 to ensure payment. |
| 06 | Claim Submission | Submit claims electronically. |
| 07 | Denial Management | Track denials and resubmit corrected claims. |
Frequently Used Podiatry CPT Codes
Nail Care
- 11719
- 11720
- 11721
- 11730
- 11750
- 11765
Skin Procedures
- 11055
- 11056
- 11057
- 11307
Injections
- 20550
- 20551
- 20600
- 20605
- 64450
Surgical
- 28001
- 28005
- 28100
- 28108
- 28285
- 28296
Wound Care
- 11042
- 11043
- 11044
- 97597
- 97598
Orthotics
- L3000
- L3020
- L3040
- L3050
Pro Tip: Always check NCCI edits before coding combinations, and use LT/RT modifiers when billing bilateral surgical procedures.
Frequently Asked Questions
How often do podiatry claims get denied?
Denials often result from incorrect ICD-10, missing modifiers, or lack of authorization.
Are pediatric podiatry codes different?
CPT codes are often the same, but ICD-10 codes differ for growth-related conditions.
Do Medicare and Medicaid cover podiatry?
Yes, coverage is procedure-specific and requires medical necessity.