I understand that CMS provides the BMAD data for the use of particular CPT codes by profession. Dr David Friedman has provided information on this exact topic. In the past, he stated that this data comes out routinely in arrears every three years. The last BMAD report was in 2024 with data from 2021.
I remember a lecture that Dr. Freidman gave a number of years ago at the Midwest Podiatry Conference on behalf of the APMA where he discussed the BMAD data analysis for the profession. I found it surprising that he stated podiatry utilizes the CPT code 11721 (nail debridement (6-10 toenails) as the most frequent in the profession versus the evaluation and management (E/M) code 99213 which ranked much lower.
Recently, the AMA provided E/M coding documentation changes that is advantageous to the podiatric profession. Therefore, you would assume that the E/M codes would be used more frequently versus nail debridement codes. I wonder if that is still an issue in the profession since these changes occurred over four to five years.
If Dr Friedman could provide a CMS link to the 2021 BMAD data for podiatry, then that would be quite helpful. Also, if he could also provide commentary regarding the continued underutilization of the E/M codes in the podiatry profession and the reasons why this is still happening.
Podiatry practices nationwide see many patients who routinely come into the office with multiple pathologies (known or unknown) outside of toenail pathology and therefore you would expect that the billing of E/M codes would out rank the debridement codes. Just my opinion.
I am certain that my colleague and partner will be adding his own comments here. My take on this is that it is that the other reason the patient came in and the only issue most DPMs document on those visits are related to the nail debridement. Hence, If the primary reason the patient came in was to have their nails debrided and there was only minimal e/m performed, that qualifies as a nail debridement visit. E/M coding is built into every sx CPT, and 11720, 11721 are sx CPT. This of course assumes you found nothing else of a separate Dx which requires your attention, dx or tx.
Bottom line, the RVU for 11720 and 11721 both have RVU for e/m built into the sx code. Thus an e/m would qualify for separate payment was if there was a separate and identifiable reason for an E/M to be built.