Business Advise for Podiatrists

Podiatry Billing Services emphasizes the importance of managing your practice as a business. You've spent many years preparing to practice. The rewards, both psychologically and financially, should be great. Yet, many well established physicians are unable to appreciate basic concepts, important in managing the financial well being of their practice.

Before discussing practice management, let's review several basic concepts.

A/R Days refers to the number of days it takes for your money to turn over. It's calculated by dividing your total accounts receivable balance by the average amount of money your practice bills out each day. In most efficient practices this number should be less than 30 days.

Overhead Expense is the cost of operating your office. It's calculated by dividing the gross income of the practice by your expenses (minus your salary). This will vary based on the size and efficiency of the practice. For a small practice it might be in the area of 50% to 60%. For larger practices it's not unusual to see an overhead expense of over 70%. Obviously, the lower your overhead expense, the less you have to work for your money.

Productivity is the amount of money your practice must generate each hour to cover your basic expenses. This is calculated by dividing your total expenses (including your salary) by 2080, the average number of hours worked in a year. Most physicians are surprised by the answer. With this number you can begin to understand what insurance contracts you can accept and which procedures are more productive

Now that you're aware of how much money you need to generate each hour of practice, lets check your coding skills. In the next few articles, Podiatry Billing Services will present a real practice scenario to see check your coding skills.

Case Study

Case: Ms. Jones has been referred by her primary care physician for evaluation and treatment. From her history and physical exam, her symptoms suggest a Morton's Neuroma. X-ray examination (two views) of both feet indicates no osseous involvement.

After spending 30 to 45 minutes discussing the problem with Ms. Jones, you proceed to give her an injection of Kenalog with Xylocaine into the neuroma (between the 3rd and 4th intermetatarsal space) and the patient is reappointed for one week to possibly repeat the injection.

How would you code the visit and procedure(s)?

Visit: 99202, 99203, 99204, 99242, 99243

X-ray exam: 73620, 73630

Injection: 20550, J1030, 64450, 64640

Since you spent 30 to 45 minutes face to face with the patient, you could code the visit as a 99203. However, since the patient was referred for consultation, a 99243 would be more appropriate. The difference in reimbursement is significant.

Since two x-rays of both feet were taken, the correct code is a 73620 with a Rt and a 73620 with a Lt modifier.

Unfortunately, the 20550 injection given with the diagnosis of Neuroma (ICD-9 355.6) is not a Medicare covered service and will be denied. If an injection is given for a nerve block other than Morton's Neuroma, use the code 64450. If a nerve block is given for a Morton's Neuroma, use the code 64455. The code 64640 is used when injecting a neurolytic agent, i.e. alcohol solution.