Denials in podiatry billing often occur for specific reasons, including:

  • Lack of Medical Necessity – Insurers may deny claims for routine foot care, such as nail trimming and callus removal, if not properly documented as medically necessary.
  • Coordination of Benefits Issues – Coverage conflicts between multiple insurers that affect patient eligibility.
  • Incorrect Coding or Modifiers – Errors in CPT codes or the use of inappropriate modifiers for podiatry-specific procedures.
  • Failure to Meet LCD/NCD Guidelines – Podiatric services often fall under Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs), requiring specific documentation.
  • Timely Filing Violations – Claims submitted past the insurer’s deadline, which varies by payer.

Best Practices for Handling Denials in Podiatry Billing

1. Analyze and Categorize Denials

  • Track denial patterns related to common podiatric procedures.
  • Categorize denials by payer, reason, and coding issue to identify trends.

2. Create a Standardized Appeal Process

  • Develop a template for appealing common podiatry-related denials, ensuring the necessary medical necessity documentation is included.
  • Submit appeals within the insurer’s deadline and provide supporting evidence, such as treatment notes and imaging.

3. Improve Documentation and Coding Accuracy

  • Train staff on podiatry-specific coding, including the use of appropriate modifiers (e.g., -25 for significant separate evaluation and management services, or -59 for distinct procedural services).
  • Ensure proper documentation supports the medical necessity of foot care treatments, including diabetic foot care and wound management.

4. Maintain Open Communication with Payers

  • Build relationships with insurer representatives to clarify coverage policies related to podiatric care.
  • Request detailed explanations for denials, particularly for routine foot care exclusions, to prevent future occurrences.

5. Monitor Timely Filing Deadlines

  • Set up alerts for approaching claim submission deadlines to ensure timely filing.
  • Keep track of each insurer’s podiatry-specific filing requirements to avoid unnecessary rejections.
  • Podiatrists can join forces through industry coalitions and professional organizations to exert collective pressure on policymakers and insurers.