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Clinical coding
Introduction
Currently two formats for the description of clinical interventions and professional activity have accepted national usage.
The Podiatrists Procedural Terminology describes direct interventions and is generally used in the private sector. It provides an accepted format for private health funds and government departments including Department of Veterans’ Affairs and Workcover to identify services provided more accurately and provides a common reference system for negotiation with appropriate bodies. This codeset has also been incorporated into the HICAPS system.
For more information about HICAPS, click here.
For information about Practice Management Systems /Software with HICAPS compatability, click here.The Minimum Data Set is commonly used in the public sector and includes methods for describing clinical activity for which the patient may not actually be present and important professional duties which are not specifically attributable to individual patients.
During 1994-96 the National Allied Health Classification Committee developed a set of allied health discipline specific intervention codes, which attempted to describe the activities of each allied health discipline.1 The intervention codes were originally developed by focus groups made up of various allied health professionals from both the acute and primary care settings and were held in various states around the country. Each allied health discipline professional association, including podiatry, also provided expert feedback and consensus on the final intervention code set.
The set of codes for each professional group were split into five groups being; assessment and evaluation; treatment; counselling and education; case management and discharge planning; and other interventions.1 These codes are now into their third edition and have been incorporated into the International Classification of Disease Version 10, Australian Modification (ICD10-AM), Revision Two. The codes in the ICD10-AM are no longer discipline specific. They contain diagnosis and procedure codes relevant to all health professionals, indexed by areas of medical specialty. The podiatry relative codes are now spread over the entire five volumes of the code set, which can make the identification of an appropriate code difficult. Although a third version is now available, Version One is still the preferred set of codes used, as the codes are discipline specific and are easily identifiable to the clinician.2Podiatrists' procedural terminology
The Podiatrists' Procedural Terminology is a list of item numbers used to describe podiatric services. It is currently used by podiatrists in private practice for describing activity and generating patient accounts. This common formula for billing services is recognised by health funds and government departments, enabling identification of services provided. The list also provides a guideline for podiatrists when generating fees for services provided but does not dictate what those fees will be. Click here for explanatory notes.
Definitions
NEW PATIENT
A patient new to the podiatrist.ESTABLISHED PATIENT
A patient known to the podiatrist with records on file.GENERAL SERVICES AND CONSULTATIONS
Include assessment, treatment plan preparation and clinical interventions performed. Other independent services or interventions may be itemised separately at the discretion of the practitioner.BRIEF SERVICE
Should be used in the case of short, uncomplicated consultations and includes cutting of non-pathological toenails in the absence of any associated local or systemic pathology.HOME - BASED, DOMICILIARY
The items are listed separately due to the additional cost incurred in transport and preparation of equipment and materials.EXTENDED CARE
Includes all hospital (public and private), nursing home, hostel and any other institution visits, where more than one patient is seen during the attendance. Fee scheduling takes into account the additional costs incurred in preparation of equipment and materials and complexity of care issues.DIAGNOSTIC SERVICES
It is presumed that a certain amount of assessment is performed with all general consultations. These codes are available for the scheduling of significant and comprehensive diagnostic examination, necessary for the development of a treatment plan and implementation of associated therapy.ORTHOMECHANICAL SERVICES
Each code is representative of an intervention performed on or provided for one foot. In the event that both feet are treated or a pair are provided, the client/patient will be billed twice, indicating left and right, on the account or receipt rendered. There are two codes for custom-made orthoses moulded to a positive cast of the client/patient's foot - one for devices which have no plaster modification (F265) and a second for devices moulded to a cast with modifications based on biomechanical measurement (F221). Fees billed for some codes involving supply of a full foot orthoses or shoe insoles are likely to vary depending on the nature of materials utilised and complexity of additions such as soft-tissue supplementary padding (F201, F221, F263, F265, F271, F341, F331).PHYSICAL THERAPY
Practitioners are advised to select the code that is most closely associated with the therapy provided. The codes may be used as an alternative to the General services codes, where an established client/patient presents for an isolated physical therapy, or where a physical therapy intervention is provided in addition to a General service.PODIATRIC SURGERY
The listed surgical procedures include the operation per se, all sterile packs and other requisite materials and equipment, local anaesthesia and normal, uncomplicated, post-operative follow-up.General Podiatric Services and Consultations
CLINIC
NEW PATIENT
F001 Brief Service (20 minutes) F002 Intermediate Service (30 minutes) includes assessment and completion of treatment plan F004 Comprehensive Service (45 minutes) includes assessment and completion of treatment plan ESTABLISHED PATIENT
F010 Brief Service (10 minutes) F012 Intermediate Service (20 minutes) F014 Comprehensive Service (30 minutes) HOME-BASED, DOMICILIARY CARE
(or extended care where only one patient is treated at visitation site)NEW PATIENT
F021 Brief Service (20 minutes) F023 Intermediate Service (30 minutes) includes assessment and completion of treatment plan F024 Comprehensive Service (45 minutes) includes assessment and completion of treatment plan ESTABLISHED PATIENT
F031 Brief Service (10 minutes) F033 Intermediate Service (20 minutes) F034 Comprehensive Service (30 minutes) EXTENDED CARE
(Multiple patients treated in one visit)NEW PATIENT
F041 Brief Service (20 minutes) F042 Intermediate Service (30 minutes) includes assessment and completion of treatment plan F043 Comprehensive Service (45 minutes) includes assessment and completion of treatment plan ESTABLISHED PATIENT
F085 Brief Service (10 minutes) F086 Intermediate Service (20 minutes) F087 Comprehensive Service (30 minutes) (See DVA Service Providers Manual for breakdown of extended care codes for various sites)
Podiatric Diagnostic Services
VASCULAR STUDIES
F101 Plethysmography, regional F104 Peripheral Flow Study (including Doppler) BIOMECHANICAL EXAMINATION
F111 Muscle Testing F114 Range of motion study and recording of measurements F115 Computerised gait analysis with detailed report (e.g.: EDG, Foot Track) F116 Treadmill and Video gait analysis with detailed report F117 Visual gait analysis with detailed report F118 Biomechanical Assessment (includes F111, F114, F117) OTHER
F163 Radiological interpretation and discussion Physical Therapy
F121 Hot / Cold therapy (eg: paraffin bath, hot or cold packs)
F141 Therapeutic exercises / Stretching F142 Neuromuscular re-education F145 Electrophysical therapy (eg: ultrasound, T.E.N.S) F147 Manipulation / Mobilisation F148 Massage F361 Strapping / Taping Orthomechanical Services and Procedures
IMPRESSIONS AND MODELS
F301 Negative impression (eg: plaster cast) of the foot or part thereof, as an independent procedure for the prescribing of an orthosis or prosthesis
F302 Positive model fabrication of the foot or part thereof (eg: plaster cast, wax) and including modifications, for the prescribing of an orthosis or prosthesis F303 Negative impression (e.g.: plaster cast) of the foot and up to the lower 1/3 of the lower leg, as an independent procedure for the prescribing of an orthosis or prosthesis F305 Positive model fabrication of the foot and up to the lower 1/3 of the lower leg, e.g.: plaster cast, wax) and including modifications, for the prescribing of an orthosis or prosthesis PRESCRIPTION ORTHOSES (i.e.: 'made-to-measure')
F201 Ankle-Foot Orthosis (i.e.: device crosses ankle joint supporting foot and lower leg)
F211 Orthodigital traction device F221 Customised Kinetic Orthosis {Functional Foot Orthosis} (custom-made to plaster model, with reference to biomechanical measurements, with intrinsic or extrinsic forefoot or rearfoot modification to influence foot and lower limb alignment) F227 Heel stabiliser, made to plaster model F261 Cushioning Orthosis F263 Pressure Relief Orthosis F265 Moulded Cast Orthosis (custom-made to uncorrected plaster model for accommodation of deformity and/or pressure relief) F267 Moulded Non-cast Orthosis (thermoplastic moulded direct to foot) F269 Heel lift F271 Interior shoe padding (eg: tri-planar wedge, toe-filler) F341 Protective device (e.g.: Otoform toe splint, latex bunion shield) PREFABRICATED ("OFF-THE-SHELF") ORTHOSES
F229 Heel stabiliser
F240 Pre-Moulded or Pre-Formed Orthosis ORTHOSIS MODIFICATIONS AND REPAIRS
F231 Orthosis repair
F233 Orthosis post - functional, forefoot or rearfoot (acrylic or other rigid material) F381 Orthosis cover - plain F383 Orthosis cover - with soft tissue supplement F385 Orthosis Post, extrinsic - forefoot or rearfoot PROSTHETIC DEVICES
F351 Digital or partial foot prosthesis
SPLINTS
F281 Dennis Browne splint
F282 Ganley splint F283 Counter Rotation system F284 Infant foot deformity - correction shoe F311 Immobilisation splint, thermoplastic, plaster, or other; below knee F312 Immobilisation splint, thermoplastic,plaster, or other; ankle / foot F315 Immobilisation splint, thermoplastic, plaster, or other; above knee F331 Traction and Training devices Footwear
F008 Initial footwear assessment (rooms) includes assessment and completion of treatment plan F025 Initial footwear assessment (home) includes assessment and completion of treatment plan F019 Follow-up footwear assessment / fitting (rooms) F605 Custom Footwear F618 Depth Width Footwear, non-custom Podiatric Surgery
NOTE: Item numbers for procedures not related to skin or nail tissues are restricted to Fellows of the Australian College of Podiatric surgeons
F119 Surgical assessment (by Fellow of the Australian College of Podiatric Surgeons)
F429 Foreign body removal (subcutaneous) F430 Foreign body removal (deep to deep fascia) F440 Avulsion of toenail F445 Excision, benign lesion F474 Excision nail and/or nail matrix. partial, for permanent removal F475 Excision nail and/or nail matrix. complete, for permanent removal F476 Excision or plastic correction of peri-ungual tissue F492 Linear repair F502 Adjacent tissue transfer F504 Digital syndactylism F421 Incision and drainage of infected or non-infected lesion F438 Debridement of post-operative wound F541 Electrocautery, chemocautery or cryocautery of benign or quiescent lesion or verrucae, with or without curettage. F546 Nail root and matrix resection with matrix sterilisation (single edge) F547 Nail root and matrix resection with matrix sterilisation (total nail) F561 Incision of soft tissue abscess (superficial) F562 Incision of soft tissue abscess (deep or complicated) F678 Percutaneous tenotomy F687 Open tenotomy F689 Capsulotomy or arthrotomy (exploration, drainage or dislocation reduction) F692 Ligament / capsular repair (digital) F694 Ligament / capsular repair (midfoot / rearfoot) F698 Plantar fasciotomy F699 Plantar fasciectomy F702 Neurectomy of peripheral nerve F703 Nuerolysis of peripheral nerve F704 Excision of cyst or small ganglion F705 Tenosynovectomy F750 Tendon transfer or transplantation (forefoot insertion) F752 Tendon transfer or transplantation (rearfoot insertion) F755 Tenoplasty (digital insertion) F757 Tenoplasty (midfoot insertion) F759 Tenoplasty (rearfoot insertion) F712 Excision or curettage of bone cyst or benign tumour (forefoot) F713 Excision or curettage of bone cyst or benign tumour (rearfoot) F715 Primary metatarsal ostectomy F716 Lesser metatarsal ostectomy F720 Lesser tarsal ostectomy F721 Tarsal ostectomy F725 Phalangeal ostectomy F728 Digital resection (supernumary or other) F731 Phalangectomy F732 Metatarsal resection (supernumerary or other) F733 Tarsal resection F736 Excision of accessory ossicle partial or total) F739 Digital arthroplasty F742 Metatarsophalangeal arthroplasty F791 Excision of tarsal coalition F782 Primary metatarsal osteotomy (distal) F783 Primary metatarsal osteotorny (proximal) F784 Lesser metatarsal osteotorny (distal) F785 Lesser metatarsal osteotomy (proximal) F786 Phalangeal osteotomy F787 Tarsal osteotomy F793 Insertion of internal fixation F794 Removal of buried wire or screw F795 Removal of buried plate or rod F852 Metatarsophalangeal arthrodesis F854 Tarsometatarsal arthrodesis F856 Interphalangeal arthrodesis F857 Tarsal arthrodesis F858 Ankle arthrodesis F860 Subtalar arthroereisis F862 Bone graft harvest F863 Bone graft insertion F872 External fixation device for distraction, rotation or angular correction osteotomy F873 Open reduction internal fixation forefoot F874 Open reduction internal fixation rearfoot F884 Arthroscopy Other Procedures
F401 Collection and handling of specimen for transfer to a laboratory
F404 Extended telephone consultation F405 Consultation outside normal practice hours F411 Medical / surgical supplies (e.g.: dressings, list drugs) F412 Written podiatric report F413 Theatre fee F414 Post-operative equipment (e.g.: post-op. shoe, crutches, walker, etc...) F985 Unlisted podiatry service or procedure Podiatrists' Procedural Terminology
BACKGROUND INFORMATION
Modern podiatric clinical practice
As providers of comprehensive footcare, today's podiatrists play an important role in the maintenance of mobility and consequently general health and independance of all members of the community. Along with the treatment of painful and debilitating foot problems, the podiatrist is a valued member of the health care team, conducting targeted screening and risk prevention, providing prophylactic treatment strategies which may delay or prevent hospitalisation and invasive treatment techniques and devising therapeutic care plans which facilitate mobility and activity.
Podiatric services offer a range of benefits for a variety of community groups. Diabetes Australia recommend a minimum annual foot assessment by a podiatrist to identify risk factors and ensure adequate foot health in order to maintain the activity level necessary for adequate metabolic control and the prevention of complications such as cardiovascular disease and amputation. Lower limb complications in this country account for the greatest number of bed-stay days of all diabetes related hospital admissions - podiatric interventions including preventative care, wound management and foot orthoses have been demonstrated to significantly reduce rates of ulceration and amputation. Other chronic conditions such as arthritis may benefit from podiatric intervention directly, particularly in the use of custom-made foot orthoses and indirectly in the overall benefits of improved mobility. An estimated 85% of persons over the age of 65 will require the services of a podiatrist and again the benefits of increased activity associated with painfree feet can be demonstrated. The chronic injuries requiring frustrating and expensive ongoing physical therapy and possibly surgery common amongst athletes are increasingly referred for podiatric intervention to correct underlying causative mechanical factors and improve rate of recovery.
The Podiatrists' Procedural Terminology (PPT) has been developed by the Australian Podiatry Council to provide a comprehensive descriptor of modern podiatric clinical practice. The range of services listed reflect the diversity of therapies provided and the resources required to deliver them safely and effectively.
General consultations
General services describe straightforward consultations which will generally include a clinical history composition, physical examination, diagnosis, preparation of a treatment plan and provision of a range of palliative therapies. These services generally incorporate the use of sterilised instruments, disposables such as gloves and antiseptics, specialist wound dressings, pharmacological agents and specialist tapes and padding materials. Separate codes are listed for extended care due to the additional costs incurred in providing podiatric services outside the normal clinical setting, however there are two separate categories which reflect the reduction in overheads when more than one patient is treated in one visit. All general services have graduated time-based allocations in recognition of the variation in complexity of various clinical presentations. All general services include an allocation for new patients in recognition of the need for more thorough clinical assessment and more complex treatment planning.
Developing an accurate clinical picture
There are times when a more comprehensive assessment will be required in order to make an accurate diagnosis or to proceed with a desired treatment plan. An individual with diabetes may benefit from a nail procedure performed under local anaesthetic, to prevent recurrent foot infection. Often a comprehensive vascular assessment will be necessary prior to proceeding, to determine suitability. Alternatively, the practitioner may determine that a permanent foot orthosis is required as an adjunct to physical therapy for an injured athlete. Accurate orthotic prescription is dependant upon detailed examination of foot and lower limb alignment (biomechanical assessment). Codes are available for comprehensive assessment procedures which may require the use of specialist technology and consume time outside the realms of general service definitions.
Physical therapy
These therapies may be provided in isolation or as part of an overall treatment plan. They are itemised separately as there may be occasions whereby a general consultation is conducted, followed by provision of a specific physical therapy on the same day. Coding these items separately allows for easy identification of a separate intervention.
Comprehensive treatment program
In order to achieve resolution of clinical symptoms, more comprehensive therapies may be required. Many chronic foot conditions are related to uneven loadbearing. It may be adequate in some cases, for example, to debride a callous as it forms and becomes painful. If attendances for this form of treatment are frequent, symptoms are not adequately relieved or there is a risk of further clincial problems developing, the practitioner may prescribe a form of orthosis to achieve load redistribution, thereby offering a more effective and permanent solution. The range of orthomechanical codes reflect the wide variety of devices which may be utilised. The Impression and Model codes are an important component of the fabrication of a custom-made orthosis. Splints are generally utilised as a short to medium term therapy and may be followed up with a permanent orthosis to maintain the correction achieved. Surgical treatment options offer problem resolution where conservative therapies have failed or are inappropriate. Separate coding reflects the additional resources required to provide safe procedures and includes normal, uncomplicated post-operative follow-up. In economic terms, long-term savings are made as the clinical condition is resolved permanently. If the procedure is performed in the clinical setting, associated hospital costs are avoided.
Addressing consumer needs
Increasingly consumers are seeking permanent solutions to clinical problems and podiatric practice has evolved to reflect this, as has the type of services for which patients are billed. Individuals are less likely to require a regular rebate for podiatry visits and generally expect health funds to recognise overall treatment programs. This also offers long-term benefit in terms of overall impact on general health.
References:
1. Woodruff I. Allied Health Minimum Data Set: Version 1. Melbourne: National Allied Health Casemix Committee, 1996.
2. Tucker S. Description of the activity of acute out-patient podiatry services. Australasian Journal of Podiatric Medicine 2003; (3):63-68.
