David J. Freedman, DPM, FASPS, CPC, CPMA, CSFAC Past Chairperson, 9 - - PowerPoint PPT Presentation

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
• f the Mid-Atlantic, LLC
• APMA Coding Committee, 10 years
• ICD 10 Team Leader APMA
• 27 years of Coding Experience

2014 BMAD Presentation From 2013 Medicare data

http://www.apma.org/YourPractice/content.cfm?ItemNumber=2426

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

Consolidation of the J’s 2013

Source: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare- Administrative-Contractors/MACContractStatus.html

2014 No Changes

A/B MAC AWARDS/CONSOLIDATION

 Noridian (JE –CA, HI, NV, American Samoa, Guam,

Northern Mariana Islands and JF –AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY) = 16

 Novitas (JL – DC, DE, MD, NJ, PA, N.VA & JH – AR, CO,

LA, MS, NM, OK, TX ) and First Coast (JN – FL, PR, US Virgin Islands) =16

 WPS ( J5 (JG) – IA, KS, MO, NE and J8(JI) – IN,MI )=6  NGS (J6 (JG) – IL, MN, WI and JK – CT,NY,MA, ME, NH,

RI,VT-NHIC) =11

 Palmetto GBA (JM/J11 – NC, SC,VA, WV)=4  CGS (J15 (JI) KY, OH )=2  Cahaba (JJ/J10 – AL, GA, TN )=3

Source: http://www.cms.gov/Medicare/Medicare-Contracting/Medicare- Administrative-Contractors/Downloads/MACs-by-State-Feb-2014.pdf

EFFECT of RUC Total Part B (billions) all allowed charges % increase Total Part B Allowed DPMs (billions) % increase DPM % of Total Allowed 2003 92.7 11 1.43 9 1.5 2004 102.2 10 1.55 8 1.52 2005 106.3 4 1.66 7 1.56 2006 110.4 4 1.71 3 1.60 2007 110.9 1.73 1 1.60 2008 114 3 1.81 5 1.60 2009 116.9 3 1.89 4 1.60 2010 122.9 5 2.03 7 1.70 2011 126.7 3 2.13 5 1.70 2012 128.1 1 2.17 2 1.70 2013 128.0 (>-1) 2.21 2 1.70

2014 Bunionectomy

2014 Bunionectomy Podiatry vs Ortho

E&M “NEW” Trends among specialties

2013 Data

2013 Data

Table 5I: 2012 Medicare Part B, Top 300* DPM

• Services. Allowed Frequency Data by Specialty,

Place of Service=OFFICE,

Alwd Chrg

All Physician s Podiatry % of Ortho % of Gen Surg %

• f

Derm % of Gen/Fam/Int %

• f

Other Phys % of

Rank HCPCS Alwd Freq

Alwd Freq Total Alwd Freq Total Alwd Freq Tot al Alwd Freq Total Alwd Freq Tota l Alwd Freq Total

127 99201

335,055 23,739 7.1% 17,681 5.3% 33,009 9.9 % 105,007 31.3 % 22,093 6.6 % 133,526 39.9 %

12 99202

2,742,567 461,237 16.8 % 202,703 7.4% 151,798 5.5 % 723,819 26.4 % 285,699 10.4 % 917,311 33.4 %

3 99203

8,787,444 1,047,172 11.9 % 1,383,812 15.7% 416,788 4.7 % 724,140 8.2% 1,102,200 12.5 % 4,113,332 46.8 %

33 99204

7,767,550 57,128 0.7% 493,443 6.4% 329,515 4.2 % 44,454 0.6% 1,151,152 14.8 % 5,691,858 73.3 %

208 99205

2,511,939 1,519 0.1% 58,414 2.3% 95,818 3.8 % 2,481 0.1% 364,641 14.5 % 1,989,066 79.2 %

106 99211

6,544,970 71,707 1.1% 42,122 0.6% 62,231 1.0 % 69,643 1.1% 3,182,547 48.6 % 3,116,720 47.6 %

5 99212 16,033,231 2,334,399 14.6

% 1,357,870 8.5% 569,301 3.6 % 2,372,709 14.8 % 3,169,996 19.8 % 6,228,957 38.9 %

2 99213 90,367,677 3,942,780

4.4% 4,769,105 5.3% 1,137,623 1.3 % 5,005,042 5.5% 38,250,063 42.3 % 37,263,06 4 41.2 %

19 99214 75,385,942 198,082

0.3% 1,610,912 2.1% 555,147 0.7 % 906,005 1.2% 35,961,285 47.7 % 36,154,51 1 48.0 %

161 99215

8,061,029 4,010 0.0% 123,798 1.5% 105,163 1.3 % 15,834 0.2% 3,316,292 41.1 % 4,495,932 55.8 % $ Did go up, rank impoved, % is same

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

Oklahoma $10,587,091 203,821 179,979 88 Minnesota $9,629,158 211,333 186,608 88 Connecticut $26,905,571 601,046 529,013 88 Utah $7,821,104 161,883 142,141 88 Idaho $3,349,558 66,820 58,566 88 Louisiana $13,190,917 269,349 231,091 86 Texas $79,823,063 1,563,785 1,341,398 86 New Mexico $7,535,609 139,636 118,013 85 Mississippi $7,812,115 170,310 142,894 84 Colorado $10,598,930 216,593 169,884 78

What Does It Mean That Minnesota has 86.7%

 13.3% of the claims are being denied!  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%.

Podiatry Top 10 for 2012

Chg Allowed Rank HCPCS APMA Short Descriptor Charges Total Top 300 codes

$2,006,021,461

1 1 11721 Nail debridement, any method, 6+

$310,469,745

2 2 99213 Office/outpatient visit, estab, level 3

$291,956,732

3 3 99203 Office/outpatient visit, new, level 3

$113,545,640

4 4 11056 Paring/cutting benign hyperkeratotic les, 2-4

$104,079,943

5 5 99212 Office/outpatient visit, estab, level 2

$103,895,296

6 6 11720 Nail debridement, any method, 1-5

$70,303,997

7 9 11042 Debridement, skin & subcut tissue

$52,743,991

8 7 11730 Nail avulsion, partial/total, single

$50,593,091

9 8 97597 Remove devit tiss, w/o anes <20 sqcm

$47,352,537

10 10 11055 Paring/cutting benign hyperkeratotic les, 1

$42,564,818

How does Combo coding help or hurt you financially in 2013? 11721 Vs. 11720+11719 or 11720+G0127? 11721 $44 (National average 2013 up a $1 from 2012)

 Example #1

11720 $32(Up $1) + 11719 $9(Down $7) = $41 (National average 2013 this went down)

 Example #2

11720 $32 + G0127 $17 (Up $1) = $49 (National average 2013 this went up)

Table 3A: 2013 Medicare Part B, Top 300* DPM Services - Data for Podiatry Listed by Descending HCPCS

Should we be concerned with PQRS reporting 2012 vs 2013?

3017f Colorectal ca screen

doc rev

3014f Screen mammo doc rev 2022f Dil retina exam interp rev

Table 11A: 2013 Medicare Part B, CPT Category II Performance Measure Codes- Clearly Podiatry is not doing a good job

Table 11A: 2013 Medicare Part B, CPT Category II Performance Measure Codes- Podiatry is reporting

0019T

Extracorporeal shock wave involving musculoskeletal system, not otherwise specified, low energy

% of % of Avg Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Frq Chrg

TOTAL $38,707 100.0% 319 157 100.0% $247 Podiatry $33,867 87.5% 171 133 84.7% $255 Family Practice $3,912 10.1% 69 18 11.5% $217 Orthopedic Surgery $654 1.7% 22 5 3.2% $131 General Surgery $273 0.7% 1 1 0.6% $273

Table 11: 2012 Medicare Part B, CPT Category III Emerging Technology Codes

Extracorporeal shock wave involving musculoskeletal system, not otherwise specified, low energy

 2011 Podiatry was 86.2% of allowed charges

and in 2012 it was down to 84.7% and 2013 down again to 84.2%

 Reimbursement averaged $267 in 2013 a jump

vs $255 in 2012 an overall increase from 2011 which averaged $239

High Energy CPT III is being used vs 28890-

Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia

This chart shows in 2012 44% of Medicare total allowed charges paid to top 5 states down from 45% in 2011. Table 9 a

Allowed % of Tot Part B Charges Alw Chg DPMs Total Part B $2,172,230,240 100.0% 17,228 Top 50 Services $1,754,881,079 80.8% 17,228 New York $188,683,583 8.7% 2,067 Florida $185,047,515 8.5% 1,401 California $179,043,051 8.2% 1,774 New Jersey $116,507,238 5.4% 923 Illinois (up from 6th) $105,968,990 4.9% 986 Pennsylvania(down to 6th) $105,327,358 4.8% 1,116 Michigan $86,265,171 4.0% 644 Texas $79,823,063 3.7% 920 Ohio $70,601,866 3.3% 857 Massachusetts $43,472,019 2.0% 398 Indiana $38,703,099 1.8% 293 Georgia $37,526,741 1.7% 376 North Carolina $32,164,560 1.5% 306 Maryland (up from 16th) $29,602,907 1.4% 391 Missouri (down from 15th) $27,366,121 1.3% 238 Connecticut $26,905,571 1.2% 270

Table 9A: 2012 Medicare Part B, Top 50* DPM Services by State, then calculated enrollees/DPM

Alwd Freq Allowed per 1000 Part B Enrollees Charges Benes Enrollees DPMs

Per DPM

Total Part B $2,172,230,240 1,157 32,819,585 17,228 1905 Top 50 Services $1,754,881,079 951 32,819,585 17,228 1905 Arkansas $8,979,611 376 429,891 70 6141 Mississippi $7,812,115 329 434,499 71 6120 Alabama $17,874,358 496 645,389 144 4482 West Virginia $6,646,815 503 280,286 63 4449 South Carolina $19,469,673 575 640,593 146 4388 Oklahoma $10,587,091 370 486,495 117 4158 Kentucky $17,896,902 558 614,622 155 3965 North Carolina $32,164,560 482 1,208,610 306 3950 Kansas $11,017,360 614 364,884 96 3801 Vermont $2,005,975 380 101,894 27 3774 Nebraska $6,811,698 589 232,559 66 3524 Wyoming $1,448,048 362 74,434 22 3383 South Dakota $2,647,424 433 114,469 34 3367 North Dakota $1,778,363 372 90,483 27 3351 Tennessee $22,073,882 524 748,649 230 3255 Louisiana $13,190,917 469 492,380 152 3239

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

Total Allowed Charges for DPM Total Medicare Enrollees Ave Dollars allowed to DPM/ each Enrollee Allowed Frequency All DPM Services % Increase total allowed services # ALLWD SVS PER ENROLLEE 2003 $1,427,117,394

42,121,133

$43.03 30,331,782 7.03 0.91 2004 $1,554,205,550

42,359,734

$43.08 32,654,523 7.11 0.91 2005 $1,663,096,709

43,404,885

$50.54 34,354,874 4.95 1.04 2006 $1,712,688,853

44,067,816

$53.79 35,131,448 2.21 1.10 2007 $1,728,277,758

44,132,245

$55.22 35,567,113 1.22 1.14 2008 $1,810,207,399

44,831,390

$58.67 36,284,399 1.98 1.18 2009 $1,891,584,375

45,484,782

$61.41 37,243,106 2.57 1.21 2010 $2,029,824,536

46,589,141

$65.89 38,370,556 2.94 1.25 2011 $2,127,109,659

47,672,971

$57.00 37,715,022 (-1.70) 1.26 2012

$2,172,230,240 32,819.515

$57.00

37,982,805

0.71 1.16 2013

$2,206,666,655 31,907,218

$60.00

37,437,479

1.02 1.17

Table 13B: 2012 Medicare Part B, CPT 64455, 64632, 64640 Data by Specialty 64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton's neuroma) % of % of Avg Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Chg Chrg TOTAL $2,664,019 100.0% 70,956 61,346 100.0% $43 Podiatry $2,514,486 94.4% 66,478 57,794 94.2% $44 Orthopedic Surgery $97,719 3.7% 2,513 2,253 3.7% $43

64632 Destruction by neurolytic agent; plantar common digital nerve % of % of Avg Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Chg Chrg TOTAL $2,138,918 100.0% 35,612 27,759 100.0% $77 Podiatry $2,130,239 99.6% 35,448 27,639 99.6% $77 Physical Medicine And Rehabilitation $1,871 0.1% 23 23 0.1% $81 Orthopedic Surgery $1,647 0.1% 29 20 0.1% $82

64640 Destruction by neurolytic agent; other peripheral nerve or branch % of % of Avg Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Chg Chrg TOTAL $11,568,729 100.0% 82,451 71,344 100.0% $162 Podiatry $6,320,127 54.6% 37,503 32,292 45.3% $196 Interventional Pain Management $1,574,540 13.6% 15,166 13,080 18.3% $120 Physical Medicine And Rehabilitation $1,110,205 9.6% 7,761 6,988 9.8% $159 Anesthesiology $1,081,756 9.4% 10,134 8,990 12.6% $120 Pain Management $563,669 4.9% 5,278 4,510 6.3% $125 Neurology $311,221 2.7% 1,881 1,650 2.3% $189

So, what problem is there that Podiatry continues to bill 64640 in 2012 vs 2013?

Table 13D: 1998 - 2013 Medicare Part B Allowed Charges and Allowed Frequency Data for All Providers and Podiatry, Grouped by Procedure Category Allowed Charges Category 1998 2002 2006 2011 2012

2013

Hammertoe All Providers $31,018,849 $48,126,193 $36,879,087 $39,809,110 $44,232,894 $47,333,755 Podiatry $25,203,974 $39,968,602 $30,510,488 $32,539,912 $36,145,289 $38,557,054 % of total 81.3% 83.0% 82.7% 81.7% 81.7% 81.5% Bunionectomy All Providers $21,591,949 $25,777,426 $25,000,661 $24,892,036 $25,153,937 $25,436,474 Podiatry $16,848,089 $20,662,538 $20,652,310 $20,563,612 $20,734,691 $20,856,200 % of total 78.0% 80.2% 82.6% 82.6% 82.4% 82.0% Metatarsal All Providers $9,885,170 $14,034,879 $12,937,644 $14,670,495 $14,528,906 $14,916,924 Podiatry $6,281,708 $9,477,941 $9,278,927 $10,839,523 $10,737,530 $11,055,806 % of total 63.5% 67.5% 71.7% 73.9% 73.9% 74.1% Rearfoot All Providers $3,935,605 $5,319,763 $5,164,395 $6,148,304 $5,981,721 $6,178,523 Podiatry $2,641,116 $3,439,755 $3,377,912 $3,964,450 $3,892,349 $3,959,918 % of total 67.1% 64.7% 65.4% 64.5% 65.1% 64.1%

Table 13A: 2012 Medicare Part B, Amputation Services

Compared top CPT's 2012 28800 28805 28810 28820 28825 TOTAL 514 3238 5340 12,250 6404 27746 2011 28800 28805 28810 28820 28825 TOTAL 487 2925 5214 11792 6158 26,576 2010 28800 28805 28810 28820 28825 TOTAL 463 2714 4848 11011 5354 24390 Are Diabetic Shoes and Inserts having an impact on preventing amputations? Or has the inability to provide these services caused more amputations? Table 13A: Medicare Part B Trend: Amputations are on the rise. Compare the Top CPT Amputation Codes submitted frequency 2010-2013 2013 28800 28805 28810 28820 28825 TOTAL 675 4361 6987 15,954 7751 35728 2012 28800 28805 28810 28820 28825 TOTAL 514 3238 5340 12,250 6404 27746 2011 28800 28805 28810 28820 28825 TOTAL 487 2925 5214 11792 6158 26,576 2010 28800 28805 28810 28820 28825 TOTAL 463 2714 4848 11011 5354 24390

Amputations in the US as a % had NOT increased 2010-2012, 3 years period

11755 Biopsy of Nail Unit any concerns?

Modifier 59: What codes do you think are the most common?

Modifier 59 For ALL Providers which CPT Codes Rank High?

DME Regions:

Table 14F: 2012 Medicare Part B, Diabetic Shoe DME Codes Data by HCPCS by Specialty

A5500 Diab shoe for density insert

% of % of Avg Allowed Total Submitted Allowed Total Alwd SPECIALTY Charges Alw Chg Frequency Frequency Alw Frq Chrg TOTAL $106,171,369 100.0% 1,723,007 1,560,817 100.0% $68 Podiatry $37,177,065 35.0% 608,384 545,734 35.0% $68 Medical Supply Company - other $22,486,322 21.2% 361,611 330,513 21.2% $68 Pharmacy $12,784,098 12.0% 206,800 188,195 12.1% $68 Individual Certified Orthotist $7,786,667 7.3% 125,822 114,728 7.4% $68 Medical Supply Company w-Cert Prosthetist- Orthotist $5,461,280 5.1% 87,723 80,275 5.1% $68 Individual Certified Prosthetist $4,975,468 4.7% 80,619 72,901 4.7% $68 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 Pedorthic Personnel $1,005,551 0.9% 15,833 14,817 0.9% $68

Diabetic shoe trends 2010-2013

 Podiatry allowed in 2010 was

41,192,045 and represented 33.9% and the average allowed charge was $67.

 Podiatry allowed in 2012 was

37,177,064 and represented 35% and the average allowed charge was $68.

 Podiatry allowed in 2013 was

34,508.934 and represented 35% and the average allowed charge was $69. Are you concerned that there is another 10% decrease in allowed charges?

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

Ran k

HCPCS APMA Short Descriptor Charges Alw Chg Frequency Frequency Alw Frq Alw Chg Assgn Total Top 300 codes $152,367,979 100.0% 3,185,718 2,808,011 100.0% $54 99.9%

1 A5500 Diab shoe for density insert

$37,177,065 24.4% 608,384 545,734 19.4% $68 0.0%

2 A5512 Multi den insert direct form

$26,525,349 17.4% 1,056,310 955,222 34.0% $28 0.0%

3 A5513 Multi den insert custom mold

$25,594,294 16.8% 688,301 618,966 22.0% $41 0.0%

4 L4360 Pneumati walking boot prefab

$12,865,063 8.4% 54,997 50,240 1.8% $256 0.3%

5 L1970 Afo plastic molded w/ankle j

$5,485,211 3.6% 8,960 8,086 0.3% $678 192.3%

6 L1940 Afo molded to patient plasti

$5,064,948 3.3% 11,392 10,571 0.4% $479 40.1%

7 L4396 Static AFO

$4,830,782 3.2% 36,374 31,637 1.1% $153 0.7%

8 L1971 AFO w/ankle joint, prefab

$3,853,352 2.5% 9,733 9,093 0.3% $424 33.0%

9 L2330 Lacer molded to patient mode

$3,279,604 2.2% 9,505 8,920 0.3% $368 6399.1%

10 L3000 Ft insert ucb berkeley shell

$3,122,214 2.0% 39,937 11,995 0.4% $260 10.8%

11 L1902 Afo ankle gauntlet

$1,885,814 1.2% 27,408 24,606 0.9% $77 1.0%

12 L5000 Sho insert w arch toe filler

$1,762,219 1.2% 4,506 3,481 0.1% $506 1.8%

13 L1906 Afo multiligamentus ankle su

$1,576,062 1.0% 15,260 14,158 0.5% $111 1.3%

14 L2820 Soft interface below knee se

$1,540,280 1.0% 20,368 18,666 0.7% $83 5185.1%

15 L4386 Non-pneum walk boot prefab

$1,450,884 1.0% 11,159 10,030 0.4% $145 6166.4%

Table 14E: 2012 Medicare Part B, Top 50* DME and HCPCS Level II Codes Data for Podiatry Listed by Ascending HCPCS by DME Regional Carrier

#1

Avg Alwd Chrg Sub Freq Alwd Freq Region DM E Allowed Submitted Allowed Alw d per 1000 per 1000 per 1000 Alwd Chrg Sub Freq Alwd Freq Part B Region HCPCS APMA Short Descriptor Re gio n Charges Frequency Frequency Chr g Benes Bene s Bene s per DPM per DPM per DPM Enrollees DPMs A5500 Diab shoe for density insert A $10,702,448 171,934 157,319 $68 $1,562 25 23 $1,931 31 28 6,853,870 5,542 A5500 Diab shoe for density insert B $8,064,606 127,579 118,373 $68 $1,279 20 19 $2,392 38 35 6,304,103 3,372 A5500 Diab shoe for density insert C $12,941,001 212,734 189,852 $68 $1,046 17 15 $2,768 45 41 12,371,478 4,676 A5500 Diab shoe for density insert D $5,469,009 96,137 80,190 $68 $750 13 11 $1,507 26 22 7,290,134 3,629

#2

Avg Alwd Chrg Sub Freq Alwd Freq Region DM E Allowed Submitted Allowed Alwd per 1000 per 1000 per 1000 Alwd Chrg Sub Freq Alwd Freq Part B Region HCPCS APMA Short Descript

• r

Reg ion Charges Frequency Frequency Chrg Benes Benes Benes per DPM per DPM per DPM Enrollees DPMs A5512 Multi den insert direct form A $7,731,837 304,307 279,069 $28 $1,128 44 41 $1,395 55 50 6,853,870 5,542 A5512 Multi den insert direct form B $5,709,054 219,923 205,290 $28 $906 35 33 $1,693 65 61 6,304,103 3,372 A5512 Multi den insert direct form C $9,434,915 375,350 339,392 $28 $763 30 27 $2,018 80 73 12,371,478 4,676 A5512 Multi den insert direct form D $3,649,543 156,730 131,471 $28 $501 21 18 $1,006 43 36 7,290,134 3,629

#3

Avg Alwd Chrg Sub Freq Alwd Freq Region Chrg DM E Allowed Submitt ed Allowed Alw d per 1000 per 1000 per 1000 Alwd Chrg Sub Freq Alwd Freq Part B Regio n Rank HCPCS Re gio n Charges Freque ncy Frequen cy Chr g Benes Bene s Bene s per DPM per DPM per DPM Enrollees DPMs 3 A5513 A $6,934,898 184,298 168,219 $41 $1,012 27 25 $1,251 33 30 6,853,870 5,542 3 A5513 B $5,705,731 147,785 137,757 $41 $905 23 22 $1,692 44 41 6,304,103 3,372 3 A5513 C $8,832,571 238,580 213,429 $41 $714 19 17 $1,889 51 46 12,371,478 4,676 3 A5513 D $4,121,094 117,638 99,561 $41 $565 16 14 $1,136 32 27 7,290,134 3,629

#4

Avg Alwd Chrg Sub Freq Alwd Freq Region DME Allowed Submit ted Allowe d Alwd per 1000 per 1000 per 1000 Alwd Chrg Sub Freq Alwd Freq Part B Regio n HCPCS APMA Short Descript

• r

Regi

• n

Charges Freque ncy Freque ncy Chrg Bene s Bene s Benes per DPM per DPM per DPM Enrollees DPMs L4360 Pneuma ti walking boot prefab A $2,518,953 10,384 9,387 $268 $368 2 1 $455 2 2 6,853,870 5,542 L4360 Pneuma ti walking boot prefab B $2,123,338 9,452 8,869 $239 $337 1 1 $630 3 3 6,304,103 3,372 L4360 Pneuma ti walking boot prefab C $5,419,582 23,598 21,708 $250 $438 2 2 $1,159 5 5 12,371,478 4,676 L4360 Pneuma ti walking boot prefab D $2,803,191 11,563 10,276 $273 $385 2 1 $772 3 3 7,290,134 3,629

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

• r 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/met atarsal 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

• rthotic 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

Thank You for participating in the 2014 BMAD Presentation of 2013 Data

David J. Freedman, DPM, CPC, CPMA, CSFAC Email: djfreedman@icdtenhelp.com