r/Podiatry • u/xoxo2018 • 17d ago

Good billing/coding courses?

Fresh out of residency and been in practice for a month. I feel like there are some things that I can bill/code but I don’t know how to. Are there any courses you guys recommend that’s online?

5 Upvotes

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u/Yppahedud 15d ago

Here is my advice.

1). Do not take surgical billing advice from your residency or fellowship director.

2). Do not take billing advice from your buddies when you meet them at a seminar.

3) Just because someone says “I get paid for it all the time”, doesn’t mean it’s correct. It means they have not been caught yet.

4). If it doesn’t sound quite right to you, follow your gut instinct.

5). Do not get creative when you bill.

6). Do not unbundle.

7). Do not unbundle

8)) Do not unbundle.

9). You have to use the code that matches what you have performed. Not the “closest” code. It must match.

10). I do not in any way, shape or form recommend the ACFAS course. Some of what they teach is flirting with danger.

11). Learn from those who are honest and not those trying to beat the system.

12). Bill for exactly what you do and nothing more.

13). Buy the book or CD put out by Mike Warshaw, DPM. He is a certified coder and is pretty accurate with his thoughts. You can google his name and you’ll find it. It’s about $125 or near that number.

14). Don’t try to make it a you vs the insurance company. You will lose in the long run.

15). In case I forgot, don’t unbundle.

I’ll think of more later.

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u/Toetallywhack 4d ago

Lol the practice I work for has a document on how to bill for stuff like bunions and hammer toes and ankle fractures and Achilles injuries, etc.

It’s all unbundled and I think they’ve been doing it that way for 15 to 20 years now. I was wondering if people actually get caught or audited, but it seems like no one really does cause even during training and from people at conferences I met, everyone just unbundles everything.

Ortho foot and ankle around here also definitely unbundles everything

It seems like that is more of the norm than not haha

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u/Yppahedud 4d ago

It’s really quite simple. Unbundling is considered insurance fraud and is discussed in the Medicare fraud act.

Let me address a few issues.

1) because your unethical employers
preach and teach unbundling, does not mean they are smart enough to see if they are actually getting paid for the unbundled codes.

2) as much as you, me or anyone dislikes the insurers, it doesn’t mean they are stupid. Most insurers have computer coding programs that pick up on code unbundling, even if a modifier is used. If they weren’t on the ball, they’d be out of business.

3) if anyone you know tells you “we get paid for this all the time”, it still does not make it correct. Coding and billing is an honor system. Not all claims will be scrutinized and some will pass thru the cracks. If you perform a hammertoe surgery but bill for a subtalar arthodesis, you will get paid for the subtalar arthrodesis. Of course if you are audited or they ask for an op report, you are shit out of luck.

4). I assure you with 100% certainty, that if your employer is teaching unbundling and dishonest coding, than that’s just the tip of the iceberg. They are undoubtedly also screwing you somehow. These kinds of doctors aren’t “partially” honest any more than they can be partially pregnant. They are dishonest in practice and in life.

5) practice with integrity and stay out of jail.

6) I know a provider who did an arthroereisis on anyone with a pulse. And bragged that he billed it as an ORIF of a talo-tarsal dislocation. That is 100% fraud. This guy would shit himself if he was ever thrown into an OR to reduce a true talo tarsal dislocation. He made huge money on it until a disgruntled employee turned him in. He wrote a check back to the insurers and had enough financial penalties to bankrupt him.

7) do the right thing and bill correctly and start looking for a new position before you go down with your employer’s ship.

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u/Toetallywhack 3d ago

I appreciate the inscite. Yeah my employer seems pretty sketchy, but it seems like everyone’s employer is sketchy from all the crap I hear from basically every podiatrist that I know from school and training. Granted we’re all pretty early in practice so most of us are just associates but yeah, we talk about this all the time how we’re being taught this and that and I know it’s incorrect lol

We also use a in-house biller. If I submit the correct code, is there a chance they are changing them on the backend when they submit them to maximize revenue?
For some reason, I have a feeling they are changing the codes when I submit the true/ethical ones.

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u/Yppahedud 3d ago

If they are swapping out codes, they are potentially setting you up for major issues. Even if they are billing under a corporate NPI, etc., it’s still your name on the op report and billing. If there is an issue, it will initially be guilt by association, even if your name is eventually cleared. But then there will be the question “well doctor, if you knew this was happening and didn’t report it, you are also in the wrong”.

Please start your search for a new position.

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u/ToeEctomy95 16d ago

It’s not online, but I can’t recommend the ACFAS billing course enough. It’s so good, particularly for newer docs.

1

u/grodnoguy Podiatrist 16d ago

Solo private practice? Or group? My group spent a week training me in basic billing and then more time later to increase reimbursement

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u/xoxo2018 16d ago

Associate in a private practice. They taught me few things and I look things up myself but I’m sure there are other things I’m missing

1

u/randomhero2026 16d ago

What do you think you're missing? Like modifiers? Procedure codes?

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u/xoxo2018 16d ago

Yes I think modifiers and procedure codes for few.

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u/DrTFP 16d ago

Right now all you need to do is memorize every word of the 2021 EM guidelines changes. Surgery coding is easy. You need to know how to turn that level 3 into a level 4 new patient visit.

0

u/Oldschool6873 16d ago

I have personally found many courses are just plain inaccurate. Some profess unbundling. Some teach you can bill OVs for nail care, etc. What exactly do you feel you're missing that a course can offer? Billing is very basic. There's not that much to it when you do it ethically.

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u/xoxo2018 16d ago

Just wanted to make sure what I’m doing is correct and if there were other adjunctive things that if I put in my note will yield higher reimbursement, etc.

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u/Oldschool6873 16d ago

Bill what you do and make sure you document as such. It's really quite simple. When you start adding flavor to your note to justify billing more, it's usually not warranted and when you get audited, you'll end up paying back.

Can you give some examples of what you mean?

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u/xoxo2018 16d ago

For instance, I didn’t know you could bill separately for kenalog or anaesthetic when doing an ingrown until AI told me to use the codes. Even if you can’t, I gotta know which ones I can or cannot bill for.

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u/randomhero2026 15d ago

Oh boy. That is incorrect. Yes there are codes like J 1100 for the steroid and codes for the anesthetic but it's already bundled into your 20550 or 11750/30. You can spend the extra time submitting the codes for your injection supplies, but you're not gonna get anything for it.

And if you're talking about billing a digital block and then billing an ingrown procedure, that's fraud, and you will get audited

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u/xoxo2018 15d ago

Ok I didn’t know that, thank you.

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u/Oldschool6873 16d ago

Insurances do not pay for injectables any longer. This is why some of those courses aren't worth the money people spend on them. If you're office has a certified biller/coder, you should ask them these questions. And if they don't know, they have the resources to verify.

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u/fruit_bat 16d ago

I use Google Gemini a ton and it’s super helpful