Updated June 20, 2023
APMA met again with Aetna leadership last week on June 12, 2023, to address the ongoing issues related to coding and billing for at-risk footcare billed with the -59 modifier, the latest meeting of several in the past 12 months. After APMA collected and submitted to Aetna leadership several examples of inappropriately denied claims with supportive redacted case notes, Aetna acknowledged that many of these denied claims were billed correctly and likely improperly denied. They are working on an update that will hopefully include a solution to address the inconvenience this inappropriate edit has created for podiatric physicians and their patients.
In the meantime, APMA encourages members to continue to document carefully and to appeal when you feel that claims were improperly denied, and your record supports payment. APMA has created a helpful -59 Modifier Tool Kit that includes tools and resources to improve your chances of success.
For any questions or concerns, please contact APMA’s Health Policy and Practice Department