Procedure-Specific Billing
Specialized Billing for Every Podiatry Service
Each podiatry service category carries its own coding rules, modifier requirements, and Medicare documentation standards. ProtoMed's certified team handles every service type correctly, preventing the class findings errors, orthotics documentation gaps, and nail code mismatches that cost podiatry practices revenue every day.
Routine Foot Care & Class Findings Billing
Medicare covers routine foot care only when the patient has documented class findings: systemic conditions (diabetes, peripheral arterial disease, peripheral neuropathy) that make routine care medically necessary. The claim must include the correct Q modifier (Q7, Q8, or Q9) corresponding to the number of class findings documented in the record. We verify class findings documentation before every routine foot care claim and apply the correct Q modifier to prevent automatic Medicare denial.
Nail Debridement & Nail Procedure Billing
Nail debridement coding depends on the number of nails treated: CPT 11720 covers up to five nails, CPT 11721 covers six or more. Nail avulsions and matrixectomies require precise code selection based on whether the procedure is partial or total and the technique used. We accurately count treated nails on every debridement claim, select the correct avulsion and matrixectomy codes, and ensure the documentation supports each procedure billed.
Diabetic Foot Care & At-Risk Documentation
Diabetic patients qualify for more frequent foot care visits and additional covered services, but only when the clinical record documents the specific conditions that place the patient "at risk" for foot complications. Missing at-risk documentation is the most common source of diabetic foot care denials. We verify at-risk documentation requirements for every diabetic patient encounter and ensure the clinical record supports the frequency and type of foot care services billed.
Custom Orthotics & DME Billing
Custom-molded orthotics are billed using HCPCS L-codes, require detailed casting or scanning documentation, physician prescription evidence, and LCD compliance for the specific condition being treated. Prefabricated orthotics use different codes than custom devices. DME prior authorization from most commercial payers is required. We accurately code every orthotics and DME encounter with the correct HCPCS codes, manage prior authorization, and ensure the documentation meets LCD requirements for each device.
Wound Care & Ulcer Debridement Billing
Podiatric wound care, including debridement of diabetic foot ulcers, pressure wounds, and venous stasis ulcers, involves selective and non-selective debridement codes that must be selected based on the technique used. Wound size determines the correct code for active wound care procedures. We accurately code every wound care encounter by technique and wound dimensions, ensure medical necessity documentation is complete, and manage prior authorization for advanced wound care therapies.
Surgical Podiatry & Global Period Billing
Podiatric surgical procedures, bunionectomies, hammertoe repairs, flatfoot correction, and fracture fixation, carry 10-day and 90-day global periods during which post-operative care is bundled into the surgical fee. E/M visits within the global period require specific modifier use (-24 for unrelated visits, -79 for unrelated procedures). We manage global period tracking for every surgical case and apply the correct modifiers when separately billable services are provided during the global period.
