Reference to a medical biller?

[jfoxcpacfp]

A podiatrist client is starting a side gig (IC) with a hospital and thinks he can do the billing better himself (thinks the hospital is "screwing it up"). He needs advice from a medical biller, specifically coding/billing for podiatry (of course). Willing to pay for the consult. Any referrals out there? He is in CA, if that matters.

[jfoxcpacfp]

The specific question he has is:

"...if I perform a service 11721 at a POS 13, should it be a facility or non facility fee?"

Maybe a podiatrist on this forum has the answer? Grateful for any advice!

[ajm184]

I know someone who should be able to answer, give me a couple hours and I will revert.

[q-school]

If I understand the question, in my world, pos 13 means assisted living center and for us answer is unequivocally non facility. However I am not a podiatrist or a biller.

[jfoxcpacfp]

Rex wrote:

I get worried when people feel they can code better but ask what seems like something they should know. I could train a coder for my codes and I believe most doctors should get to that level. I believe it’s just like investing. Hopefully a podiatrist comes along with your answer though.

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I do understand what you're saying and I tend to agree. In this specific situation, it appears to be more egregious in that he believes the hospital is making errors and charging a high fee. I'm just the advisor trying to find a solution, though.

[ajm184]

As Q-School stated above, POS 13 is an assisted living facility. If OP is working at a hospital (i.e. employed/W-2), and the physician is travelling to the ALF it is non-facility.  Perhaps the hospital medical biller is billing as facility?  Reimbursement is likely higher under facility vs non-facility.

[ajm184]

Add on:  The code is for a nail debridement and is a common procedure in an ALF.  Medicare comps + or - $45 for this code.

[jfoxcpacfp]

ajm184 wrote:

Add on:  The code is for a nail debridement and is a common procedure in an ALF.  Medicare comps + or – $45 for this code.

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Yes, this is an ALF. Will pass all of the above along. Mucho gracias!