APMA Advocacy Leads to -59 Modifier Change

January 15, 2021

As a result of APMA’s advocacy efforts, the National Correct Coding Initiative (NCCI) updated Chapter I of the NCCI Policy Manual for Medicare Services in Section E.1.d.(3), Example #2, to reflect a prior determination by CMS specifying that use of Modifier 59 or X[ESPU] is acceptable if the procedures described by CPT® 11720 and 11055 are conducted on lesions that are anatomically separate from one another—even if on the same digit.

Effective January 1, 2021, the NCCI Policy Manual Chapter I now includes an example that reads as follows:

Example 2: The Column One/Column Two code edit with Column One CPT code 11055 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion) and Column Two CPT code 11720 (Debridement of nail(s) by any method(s); one to five) should not be reported together for services performed on skin distal to and including the skin overlying the distal interphalangeal joint of the same toe. Modifiers 59 or –X{EPSU} should not be used if a nail is debrided on the same toe on which a hyperkeratotic lesion of the skin on or distal to the distal interphalangeal joint is pared. Modifiers 59 or –XS may be reported with code 11720 if 1 to 5 nails are debrided and a hyperkeratotic lesion is pared on a toe other than 1 with a debrided toenail or the hyperkeratotic lesion is proximal to the skin overlying the distal interphalangeal joint of a toe on which a nail is debrided.

This victory ensures the NCCI Policy Manual language is consistent throughout and accurately reflects CMS policy.

APMA’s 59 Modifier Workgroup was formed last year to address this discrepancy and develop a Routine Foot Care and -59 modifier toolkit. The toolkit includes educational materials and resources to help members when Medicare Advantage plans, Medicaid Managed Care Organizations, or other commercial plans deny covered nail care (CPT® 11720/11721) when callus care (CPT 11055-11057) is provided on the same date.

The workgroup is pleased with this victory and will now work toward the coverage of nail debridement without any restrictions related to callus paring or cutting.

For more information visit www.apma.org/59toolkit.

In Memoriam – Mona Feigenbaum, DPM

January 7, 2021

From the Echovita.com website:

It is with great sadness that we announce the death of Mona Ilene Feigenbaum (Dallas, Texas), who passed away on December 23, 2020, at the age of 62, leaving to mourn family and friends. Family and friends are welcome to leave their condolences on this memorial page and share them with the family.

A graveside service was held on Sunday, December 27th 2020 at the Restland Memorial Park (13005 Greenville Ave, Dallas, TX 75243). 

In Memoriam – Louis Antahades, DPM

December 7, 2020

Louis Michael Antahades, 4/26/32 -11/30/20. Born in Erie, PA where he attended Academy H.S. and Gannon Univ. Matriculated to The Ohio College of Podiatric Medicine graduating in 1956. He served in the U.S. Army stationed at Ft. Chaffee where he established a foot clinic for the service personnel. In 1958, he came to Dallas to establish his podiatry practice. He helped in organizing the Great Southwest Hospital in Grand Prairie where he also served for five years as Chairman of the Board of Trustees. His surgical experience represents well over 30 years. Dr. Antahades has authored papers in the Journal of American Podiatric Med. Assn. and articles relating to the Biomechanics of Skiing. Among his many services he was President of the Dallas County Podiatry Society, Chaired a Legislative group of Antidiscrimination bill that successfully became law in Texas. Too many rewards to mention but one that he was proud off was Humanitarian and Brotherhood of National Conference of Christians and Jews.
Music was always agreat part of his life beginning in H. S. where he played the Saxophone and Clarinet and later in the 90’s formed the Glen Dorsey Band &Orchestra performing for numerous social functions and for 10 years as the main entertainment for the Military Ball. His love of the mountains and outdoors would find him hiking, camping, skiing and serving as an instructor in Idaho for the Natl.
Forest Service. He also found time to teach Sunday School at several Greek Orthodox Churches and later enjoyed Mass with the sisters and parishioners that attended the Holy Family of Nazareth Convent in Grand Prairie. He is survived by his wife, Judyth, daughters Katina, Anastasia and Michaelina Antahades and son-in-law, Eddy Tann and step children, Macie and Lindsey.

His cremated remains will be placed at the memorial in the National Military Cemetery in Dallas.

There will be no funeral but a celebration of life sometime later. May his memory be eternal.

———-

He was a profound leader of TPMA legislative agenda. His close friend was Congressman Chris Semos.

He was a leader and loyal member of TPMA for MANY years.

Major Changes Coming in 2021 for Office/Outpatient E/M Codes

November 19, 2020

Effective January 1, 2021, CMS will be changing the way providers bill for office/outpatient E/M codes. The changes begin with reducing the documentation requirements for the history and exam components, placing the emphasis on the level of medical decision making (MDM) and total time spent in caring for the patient. See below for informational resources.

Texas Podiatric Medicine magazine article

Office / Other Outpatient Evaluation and Management Changes for 2021 training webinar: https://register.gotowebinar.com/recording/720310261709592588

Getting Ready: Documentation for E/M Coding in 2021 training webinar: https://www.apma.org/Events/CalendarEventDetail.cfm?EventID=121159

Overview of the changes: https://www.apma.org/em2021

APMA will do another webinar on December 17, 2020, to show examples on how the new E/M rules should be applied. More information on this webinar will be coming soon.

Step Into Podiatry

October 19, 2020

We are asking all podiatrists to help to promote podiatry to the next generation.

To help facilitate this process, APMA has created a webpage, Step Into Podiatry, that provides excellent resources for high school and undergraduate students. Included on the website are flyers, videos and a customizable PowerPoint presentation for prospective students, which can be used when speaking with student groups or individuals.

In Memoriam – Gilmore E. Guster, DPM

September 17, 2020

It is with a heavy heart and great sadness hearing of the passing of Dr. Gil Guster on September 12, 2020, my peer, my mentor, and especially one of my dearest friends. Gil was one of our unsung leaders of podiatry in the Houston and Clear Lake, NASA community during the ’70s through the ’90s. He never said no to helping or guiding any new podiatrist moving into the area.

He was held in great respect not only by his fellow podiatrists but also with the MD community. He will be missed by many but never forgotten. My condolences to his wife Evie who lives in the San Diego area where they have resided together for the past several years. He is also survived by his two adult children and their families.

RIP Gil.

Michael A Mineo, DPM
Galveston, TX

New Human Trafficking Prevention Training Requirement

July 15, 2020

Pursuant to House Bill 2059, certain health care practitioners are required to complete an approved human trafficking prevention training course in order to renew their license beginning September 1, 2020. The training course must be approved by the Texas Health and Human Services Commission (HHSC) and is required for each license renewal submitted on or after the effective date.

The following TDLR license types are impacted by HB 2059 and will be required to comply with the new training requirement:

· Podiatric Physician
· Podiatric Temporary Residency
· Podiatric Medical Radiological Technician

HHSC has already approved one training course and posted it on their website. Additional courses will be posted as they are approved. You can find more information on HHSC’s Texas Human Trafficking Resource Center webpage.

TPMA Online CECH Series – Webinar #1

June 16, 2020

Zoom Webinar | June 24, 2020 | 12:00 – 1:00 pm
1 CECH

Podiatric Dermatology Essentials
Speaker: Tracey Vlahovic, DPM, FFPM RCPS (Glasg)

Register now!

Your Podiatry Practice and COVID-19

March 23, 2020

Dear member,

As the effects of the COVID-19 pandemic continues, the Texas Podiatric Medical Association wants to share some important information with you and guidance for your practice during this challenging time. Below are some links that we hope will help you deal with the current situation. 

Many podiatrists are searching for answers about how to address COVID-19 in their practices and personal lives. TPMA/APMA is here to help by directing you to the most authoritative and timely news and tools. These resources are available on APMA’s COVID-19 resource page at www.apma.org/covid19 as well as an FAQ page.

PODIATRISTS CAN PROVIDE E/M SERVICES REMOTELY
A resource that may be of interest to you are APMA-developed resources on providing telehealth services. You may need to provide Telephone Services and Online Digital Evaluation and Management Services during this time. CMS has announced major changes to services that podiatrists can furnish remotely under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. This waiver allows Medicare to pay for office, hospital, and other visits furnished via telehealth. This change means podiatrists can submit CPT 99201–99215 when these services are provided remotely. Watch APMA’s webinar for guidance on coding, compliance, and documentation for these service types. As of today, telehealth can be provided for Medicare Part B (Fee for Service) and Medicare Advantage plans only. Rules and Regulations change from day to day so stay tuned for updates.

Additionally, there may be upcoming issues with patients requiring “covered routine foot care” (RFC) and/or diabetic therapeutic shoes (DTS). With regard to the RFC and DTS it is APMA’s understanding that, “DME CMD’s suggest that CMS is having discussions with all the CMD’s on many of the policy issues given that it is not possible for most folks to get into their PCP offices right now. Priority for ill patients not for those who need to be certified for shoes or routine foot care must be given.

Some coders have also suggested that if possible (based on the patient’s history, physical finding, diagnoses and the Novitas Solution’s LCD on RFG) to use non-asterisk (*) diagnoses as these do not require the patient to be seen by their attending within the past six months. This is just a suggestion and may not be appropriate for every patient’s situation. There is also the possibility that these patients can be scheduled farther out after the virus situation and the social distancing is no longer a problem.

THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT WAS SIGNED INTO LAW ON MARCH 18, 2020
In the coming days and weeks, federal regulatory agencies, including the Department of Labor (DOL) and Health and Human Services (HHS), will provide guidance on how to execute or implement the new requirements. In the meantime, employers and advisors must rely on a good faith interpretation of the act’s text. View the Families First Act

ADDITIONAL LINKS:

TEXAS DEPARTMENT OF STATE HEALTH SERVICES

TEXAS DEPARTMENT OF LICENSING AND REGULATION

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

WORLD HEALTH ORGANIZATION (WHO)

JOHNS HOPKINS UNIVERSITY & MEDICINE

CENTERS FOR MEDICARE & MEDICAID SERVICES

TEXAS WORKFORCE COMMISSION

  • TWC webpage has resources and information on actions taken by the commission in response to COVID-19. This page will be continuously updated with answers to questions about operating your business during this time. Please visit https://twc.texas.gov/news/covid-19-resources-employers.

CYBERSECURITY

  • Be aware there are fake emails coming in posing as COVID-19 informationals; these emails/sites direct you to install an applet in order to view “current” data but instead it installs a malicious program. Please be wary of any unfamiliar sites asking you to download or install anything. You can read more about it here.

Stay well and safe,

Melinda Daise
Executive Director

Steven P. Brancheau
Chief Medical Officer

CMS Announces Actions to Address Spread of Coronavirus

March 12, 2020

It is Novitas Solutions’ priority to keep you informed of updates addressing the Coronavirus (COVID-19). They have developed a dedicated Coronavirus webpage that can be easily accessed from their website home page banner and a red alert box at the top of the page. Stay informed and subscribe to the Novitas Solutions’ eNews to learn the latest Medicare news and other time-critical information.