With rising reimbursement rates fueled by increased federal investments in Medicare, Medicaid, and outpatient care, the financial outlook for podiatry practices has never been more promising. The industry has seen a steady compound annual growth rate (CAGR) of 2.3%, reaching $7.0 billion by 2023, with income projected to continue growing at a rate of 5.1%—even after setbacks experienced during the pandemic.
However, to truly benefit from this growth, podiatrists must streamline their billing processes, reduce claim denials, and implement best practices that enhance their revenue cycle. From accurate documentation to efficient coding and insurance eligibility verification, every step plays a crucial role in maximizing reimbursements.
In this article, we will share 7 actionable podiatry billing tips to help your practice improve cash flow, minimize administrative errors, and capture the full revenue it deserves.
1. Ensure Accurate Documentation Before Submitting Claims
Clear, comprehensive documentation is the key to successful claim submission. Patient records should include detailed notes on the diagnosis, the medical necessity of the procedure, and any comorbid conditions.
Many claims—especially those involving nail care or callus removal—are denied due to insufficient supporting documentation. For example, missing modifiers, incorrect patient or provider details, and insurance ID details can cause insurance claim denial.
If these crucial details remain missing in the claim request, the payor will deny the claim. The claim denial will leave you stressed due to frequent audits and repetition of tasks. So, to avoid all these hassles, you must ensure accurate documentation.
To make this all happen smoothly, you need to:
- Check and verify the patient and provider details, such as insurance ID and provider details.
- Cross-check and compare patient details with the claim details stored in your EHR systems.
- Utilize automation tools, EHR, and PMS software to ensure accuracy and consistency in the medical records.
2. Use Accurate Podiatry Codes and Relevant Modifiers
Coding errors are a significant reason for claim denials. Podiatrists provide treatments for foot and ankle diseases. They perform surgeries and treat fractures.
Remember that podiatry commonly uses six ICD-10 codes, two HCPCS, and eight CPT codes.
These procedures require specific ICD-10 and CPT codes along with their modifiers. Even a minor coding mistake can result in a claim denial, rejection, or delay for an insurance company.
That’s why assigning correct codes to podiatry procedures is essential to keep the billing process on track.
Here is how podiatrists can ensure their codes are spot on:
- Use accurate CPT (Current Procedural Terminology) and ICD-10 codes. Always double-check that the procedure codes align with the documented diagnosis and support medical necessity.
- Podiatry coders must stay updated and efficient with coding changes and payor guidelines to ensure accurate coding. Additionally, use EHR software for accuracy.
- Avoid coding mistakes such as outdated or mismatched diagnosis and treatment codes.
3. Use of Correct Modifiers to Differentiate Services
Applying the appropriate modifier is vital to accurate billing. In podiatry, Q modifiers indicate specific clinical findings that justify medically necessary foot care.
Common Q Modifiers:
- Q7 – One Class A finding (e.g., non-traumatic foot amputation)
- Q8 – Two Class B findings (e.g., absent pedal pulses, advanced trophic changes)
- Q9 – One Class B and two Class C findings (e.g., thickened toenails)
These modifiers support the medical necessity of routine foot care—especially for Medicare and other insurance payers.
Common CPT codes paired with Q Modifiers:
- 11055 – Paring of benign hyperkeratotic lesion (e.g., callus)
- 11056 – Paring of multiple benign hyperkeratotic lesions
- 11719 – Trimming of nondystrophic nails
- 11720 – Debridement of 1–5 nails
- 11721 – Debridement of 6 or more nails
- G0127– Trimming of dystrophic nails (any number)
The podiatry service providers need to:
- Use accurate modifiers to differentiate services to avoid inconsistent documentation and HIPAA violations
- Pair the correct modifier with strong supporting documentation to reduce the likelihood of denials.
- Cross-check all codes and modifiers to ensure that the modifiers are placed accurately with a relevant code.
4. Verify Insurance Coverage and Eligibility of the Patients
Before providing services, confirm the patient’s insurance eligibility and coverage. It helps determine:
- Whether the service is covered
- Patient copays or deductibles
- Whether prior authorization is needed
To ensure the eligibility of the patient for insurance coverage, you must:
- Maintain accurate medical records and clear documentation of the patients to avoid any difficulty in the claim submission process.
- Use real-time verification tools EHR software or assign this responsibility to trained front-desk staff to ensure consistency.
- Use the insurance company’s verification portals and website to verify the details related to the patient and insurer.
5. Implement Effective Denial Management Strategies
Effective denial management goes beyond identifying problems—it’s about building a proactive and reliable process to reduce future denials and recover lost revenue.
For this, you need to develop and implement effective denial management strategies.
Here’s how you can get this job done:
- Reach out to the root cause of denial, which can help to address underlying issues more effectively. Analyze denial patterns to identify errors that happen regularly.
- Foster regular interaction between healthcare providers, admin staff and billing team to discuss the claim process in detail if a payer denies a claim request.
- Implement EHR and PMS to track denial rates, causes, and trends and identify areas for improvement and effectiveness of implemented strategies.
- Automate the processes using efficient tools and billing software to reduce errors and enhance efficiency in handling denials.
6. Provide Ongoing Staff Training
Medical billing is increasingly complex due to evolving technologies and frequently updated guidelines. Providing ongoing staff training can help ensure the reimbursement process is smooth.
For training and staff support, the podiatry office owners should:
- Provide coding and HIPAA compliance training to the billing team and clinical staff with the latest coding rules, payer-specific policies, and modifier usage.
- Subscribe to newsletters from the American Podiatric Medical Association (APMA) and attend webinars on podiatric billing.
- Enable staff to communicate billing issues with the billing team/company to get timely assistance on denied claims or streamline the overall claim process.
7. Utilize Billing Software and Outsource to Billing Provider
Because the claim process can be time-consuming and complex, podiatrists might be unable to focus on the financial aspects as they must deliver swift care to their patients.
It is where a medical billing company and billing software play a crucial role.
For efficient and clean claim submission and to avoid denials from insurance companies, podiatrists need to:
- Look for software that integrates with your Electronic Health Records (EHR) system and offers effective claim management solutions.
- Utilize patient portals to improve transparency and streamline payments, which can increase patient satisfaction.
- Outsource billing to a company with vast experience and expertise that can handle overhead expenses and help minimize claim denials and errors.
Conclusion
Maximizing reimbursement in podiatry isn’t just about submitting claims—it is about building a system that combines accurate documentation, expert coding, strong processes, and the right technology. By applying these seven tips, your podiatry practice can increase revenue, reduce denials, and deliver smoother billing operations.
Are You Losing Revenue Due to Common Podiatry Billing Errors?
At Connecticut Medical Billing, we specialize in comprehensive podiatry billing services designed to help practices like yours maximize reimbursements, minimize claim denials, and optimize revenue cycle performance. Our experienced billing team is well-versed in the nuances of podiatry coding, payer guidelines, and compliance standards. Let us manage your billing—so you can focus on delivering exceptional patient care.
📞 Contact Connecticut Medical Billing today to discover how we can help strengthen your practice’s financial health.
