David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC • Past Chairperson, 9 th and 10 th Annual National APMA CAC PIAC meeting • Current CAC member Maryland • Certified Professional Coder • Certified Surgical Foot & Ankle Coder • Certified Professional Medical Auditor • Vice President, Foot and Ankle Specialists of the Mid-Atlantic, LLC • APMA Coding Committee, 10 years • ICD 10 Team Leader APMA • 27 years of Coding Experience
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David J. Freedman, DPM, FASPS, CPC, CPMA CAC PIAC mtg of 2013 BMAD Data...David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC • Past Chairperson, 9 th and 10 Annual National APMA CAC
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David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC
• Past Chairperson, 9th and 10th Annual
National APMA CAC PIAC meeting • Current CAC member Maryland • Certified Professional Coder • Certified Surgical Foot & Ankle Coder • Certified Professional Medical Auditor • Vice President, Foot and Ankle Specialists
of the Mid-Atlantic, LLC • APMA Coding Committee, 10 years • ICD 10 Team Leader APMA • 27 years of Coding Experience
In 2013, Medicare Part B total allowed charges were $128.0 billion dollars. Of this total, claims submitted by podiatrists represented $2.21 billion or 1.7 percent.
Most of the data tables presented in this report include summary data for the top 300 procedures/services for podiatrists, based on 2013 allowed charges ranking.
These top 300 procedures/services accounted for 92.8% of podiatric Medicare allowed charges in 2013.
2012 vs 2013 difference: 1) Total Part B had a $0.1 Billion Decrease in allowed charges for all providers. 2) $40 million Increase in podiatric allowed charges 3) Claims submitted by podiatrists represented 1.7% in 2013 same as 2012. 4) top 300 procedures/services accounted for 92.8% of podiatric Medicare allowed charges in 2013 vs 92.3% in 2012
2013 Podiatric E&M ranking changes compared to 2012:
1) 99212 ranking has remained 5th
2) 99213 remained same, 2nd ranked
3) 99214 moved up from 19th to 18th
4) 99203 remained same, 3rd ranked
5) 99202 remained same,12th
2013 Podiatric E&M ranking vs Ortho vs General Sx vs
Derm vs compared to 2012:
1) 99203 Is most frequently allowed by Podiatry, Ortho, General Sx and Derm. Derm submitted
almost same as 99202 and Gen/Fam/Int & Other Physicians are more commonly
submitting 99204
2) 99213 continued as the most frequently allowed in Podiatry, Ortho, Derm, Gen Sx and
Gen/Fam/Int
2013 Modifer 25 by Specialty Table 2C-2F: 2013 Medicare Part B, Evaluation &
Management Services Utilizing Modifier-25*
Table 9a: 2012 Medicare Part B, Top 50* DPM Services by State TO P 10 STATES
*(Top 50 DPM services - ranking based on 2012 allowed charges for podiatry specialty category)
% of Tot Allowed Part B Submitted Allowed %
Charges Alw Chg Frequency Frequency Paid Total Part B $2,172,230,240 100.0% 44,525,292 37,982,805 85 Top 50 Services $1,754,881,079 80.8% 34,131,234 31,223,043 91 Vermont $2,005,975 40,419 38,726 96 South Dakota $2,647,424 52,214 49,580 95 Wyoming $1,448,048 28,623 26,928 94 California $179,043,051 3,137,651 2,951,411 94 Montana $3,781,478 71,701 67,398 94 South Carolina $19,469,673 393,132 368,138 94 Virginia $26,262,846 494,906 463,297 94 Florida $185,047,515 3,229,477 3,022,910 94 Iowa $18,447,340 408,107 381,960 94 West Virginia $6,646,815 151,171 140,998 93
What Happened to Vermont?
96% in 2012 to 94% in 2013 so only 6% of the claims are being denied! Still a good job.
South Dakota best in 2013 with 95.3%, a 0.3% increase.
South Dakota, South Carolina, Iowa , Wyoming, Florida, Vermont, California, Montana,, Virginia, Montana Kansas, West Virginia and Virginia GET an “A” your claims were paid 93% or better in 2013
Table 9a: 2012 Medicare Part B, Top 50* DPM Services by State BOTTOM 10 STATES
*(Top 50 DPM services - ranking based on 2012 allowed charges for podiatry specialty category
Colorado improved from worst in 2012 to 3rd from worst, Minnesota GETS a “B” because your claims were paid 86.7% in 2013, we have no Grades of “C” in 2013.
Is something wrong when 13% of claims are not approved?
Total PART B % paid is 84.1% - This is the benchmark and podiatry is all above that mark with Minnesota the lowest at 86.7%.
1) Downward trend in number of DPM services 2) Upward trend in allowed charges 3) Downward trend Medicare enrollees (more in HMO) 4) Ave dollars per service remains up at $60
Medical Supply Company w-Cert Orthotist $4,839,817 4.6% 78,673 71,531 4.6% $68 Medical Supply Company with Pedorthic Personnel $2,179,307 2.1% 34,802 32,147 2.1% $68
Individual Certified Prosthetist-Orthotist $1,845,585 1.7% 28,972 27,183 1.7% $68 Medical Supply Company With Respiratory Therapist $1,441,488 1.4% 23,128 21,242 1.4% $68
Should you still be concerned seeing L3000-L3030? Table 14A: 2012 Medicare Part B, Top 300* DME and HCPCS Level II Codes
Data for Podiatry Listed by Ascending HCPCS *(top 300 ranking based on 2012 allowed charges for podiatry specialty category)
Chg Allowed % of Submitted Allowed % of Avg % Freq
Rank HCPCS APMA Short Descriptor
Charges Alw Chg Frequency Frequency Alw Frq Alw Chg Assgn
10 L3000 Ft insert ucb berkeley shell
$3,122,214 100.0% 39,937 11,995 100.0% $260 0.0%
83 L3001 Foot insert remov molded spe
$26,179 0.8% 553 271 2.3% $97 0.0%
63 L3002 Foot insert plastazote or eq
$46,027 1.5% 960 441 3.7% $104 0.0%
257 L3003 Foot insert silicone gel eac
$1,139 0.0% 26 7 0.1% $163 0.0%
35 L3010 Foot longitudinal arch suppo
$151,135 4.8% 2,462 1,007 8.4% $150 0.0%
19 L3020 Foot longitud/metatarsal sup
$1,130,758 36.2% 14,716 6,398 53.3% $177 0.0%
40 L3030 Foot arch support remov prem
$116,041 3.7% 4,235 1,675 14.0% $69 0.0%
Looking at our L3000 series DME CODES another year shows red flags to me and you?
Do You Feel that L3000 or L3020 should be billed to Medicare and Paid vs billed and stated Statutorily Not Covered?
How often does a podiatrist provide a foot orthotic that is attached to a leg brace to Medicare Beneficiaries?
So now you have seen the statistics Four years in a row, you make the call.
I am concerned that the rank for L3000 moved up one.
This is the DME Game, you get to decide. What state allows a podiatrist to bill for ?
This is the DME Game, you get to decide. What state allows a podiatrist to bill for ?
Are Podiatrists billing these codes in 2012 when they really are dispensing L4360 or L4386?
Chrg DME Allowed Submitted Allowed Alwd Rank HCPCS APMA Short Descriptor Region Charges Frequency Frequency Chrg
29 L2112 Afo tibial fracture soft A $37,606 91 89 $423 29 L2112 Afo tibial fracture soft B $64,245 149 144 $446 29 L2112 Afo tibial fracture soft C $93,593 240 211 $444 29 L2112 Afo tibial fracture soft D $86,147 230 218 $395
Avg Chrg DME Allowed Submitted Allowed Alwd Rank HCPCS APMA Short Descriptor Region Charges Frequency Frequency Chrg
23 L2114 Afo tib fx semi-rigid A $110,592 228 204 $542 23 L2114 Afo tib fx semi-rigid B $47,728 100 91 $524 23 L2114 Afo tib fx semi-rigid C $454,448 1,008 899 $506 23 L2114 Afo tib fx semi-rigid D $97,980 253 221 $443
Avg Chrg DME Allowed Submitted Allowed Alwd Rank HCPCS APMA Short Descriptor Region Charges Frequency Frequency Chrg
20 L2116 Afo tibial fracture rigid A $99,836 173 154 $648 20 L2116 Afo tibial fracture rigid B $82,240 144 128 $642 20 L2116 Afo tibial fracture rigid C $683,115 1,222 1,151 $593 20 L2116 Afo tibial fracture rigid D $70,654 153 143 $494
This is the DME Game, you get to decide. What state allows a podiatrist to bill for ?
This is the DME Game, you get to decide. What state allows a podiatrist to bill for ?
What states continue to allow podiatrist to bill for Knee Orthotics this was 2012?
Avg
Chrg DME Allowed Submitted Allowed Alwd
Rank HCPCS APMA Short Descriptor Region Charges Frequency Frequency Chrg
38 L1832 KO adj jnt pos rigid support A $22,136 39 35 $632
38 L1832 KO adj jnt pos rigid support B $45,968 100 73 $630
38 L1832 KO adj jnt pos rigid support C $52,672 127 91 $579
38 L1832 KO adj jnt pos rigid support D $9,266 19 15 $618