Medicare Advisory Liaison

New Medicare Data Results
The Part B Medicare data from 2017 has just been released. The complete data can be found at the APMA website. I will share some of the highlights of the data. As a reminder the data is always one year behind so 2018 data will not be available until next year. There were 58.5 million Medicare enrollees in 2017. In 2017 $138.1 billion was spent on Part B services. Podiatrists were paid $2.19 billion or 1.6% of the total. The number one code used by podiatrists in Illinois was CPT 99213 office visit code. The second highest code was CPT 11721 for nail debridement. The number one new patient code was CPT 99203 followed by CPT 99202.

The top code for bunionectomies was CPT 28296 used 81% by DPMs vs. 19% for orthopedists.

The top hammer toe correction code was CPT 28285 used 77% by podiatrists.

The top wound debridement codes were: 1) 11042 2) 97597 3) 11043 4) 11044 5) 11045.

Illinois was in the top 5 for use of CPT 11305 and CPT 11755. These codes are being used inappropriately for routine foot care and for nail clippings/biopsies. These codes should be used rarely by a podiatrist. With Illinois being in the top five for abusing these codes this could lead to audits for fraudulent billing. Podiatrists also used and billed L3000 and L3020 for orthotics to Medicare. Again these should not be billed to Medicare. If you are billing these codes to Medicare and getting reimbursed you are doing so inappropriately and could face investigation by the carrier or by the Office of Inspector General.

Top Fifteen Procedures for DPM in Illinois for 2017 (based on charges)

  1. 99213 Office/outpatient visit, estab, level 3
  2. 11721 Nail debridement, any method, 6+
  3. 99203 Office/outpatient visit, new, level 3
  4. 11056 Paring/cutting benign hyperkeratotic les, 2-4
  5. 99212 Office/outpatient visit, estab, level 2
  6. 11042 Debridement, skin & subcut tissue
  7. 11720 Nail debridement, any method, 1-5
  8. Q4131 Skin substitute, Epifix, per sq cm
  9. 11055 Paring/cutting benign hyperkeratotic les, 1
  10. 11730 Nail avulsion, partial/total, single
  11. 97597 Remove devit tiss, w/o anes <20 sqcm
  12. 99214 Office/outpatient visit, estab, level 4
  13. 73630 Xray, minimum 3 views foot
  14. 11750 Perm removal nail, partial/total
  15. 99202 Office/outpatient visit, new, level

Raw 2017 Part B Medicare Annual Data (BMAD)from APMA
Contained in the 2017 report’s list of tables are the materials available to members. If you need access to the full raw data, please contact APMA’s Health Policy and Practice department at healthpolicy.hpp@apma.org or 301-581-9200 and identify which materials you need using the list of tables.
The following data sets are the most commonly requested:

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