Podiatry Coding & Billing Alert Your practical adviser for ethically optimizing coding, reimbursement, and efficiency in podiatry practices

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1 The Coding Institute AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Podiatry Coding & Billing Alert Your practical adviser for ethically optimizing coding, reimbursement, and efficiency in podiatry practices Also Access Your Alert Online at January 2014, Vol. 6, No. 1 (Pages 1-8) In this issue CPT : New E/M Codes Capture Doc Discussions Make sure to include a written report. E/M Navigate the New-Versus- Established-Patient Maze With Expert Tips Different locations, same physician? Use established patient codes. p3 p3 EHR Mythbuster 3 EHR Myths That Could Cost Your Practice Heavily p5 Warning: Blindly relying on your electronic system could mean payer audits. You Be the Coder Diabetes Patient, Post- Amputation Reader Questions Test Your ICD-10 Coding in March p6 Know How to Without Violating HIPAA p6 Opt for First-Initial, Last-Name Privacy Protocol p7 p5 ICD-9 Coding } Avoid Tough Callus and Corn Coding Keep the jargon straight for common foot conditions. For podiatrists treating the skin of a patient s foot, one of the most commonly coded diagnoses is corns (and calluses). The condition has a slew of confusing names that may be hard to find or may not even be in your coding book and could quickly derail your claims. Deciphering all of the corn and callus terminology can be especially difficult if you work for several physicians and each one has his own way of naming the same thing, or if you ve recently started working at another practice. But you no longer have to be in the dark over a callus-related term that comes your way. Familiarize Yourself With the Jargon You may recognize the word clavus, since the ICD-9 corn/callus code (700, Corns and callosities; includes callus, clavus) names it up front. But here are a few more related words that many providers use interchangeably in their notes that you should keep in mind: Clavi (the word for more than one clavus ) Keratosis Keratoma Hyperkeratosis Intractable plantar keratosis (may be abbreviated as IPK ) Heloma Callosity Tyloma Tylosis Durum (this term refers to heloma durum, which is considered a hard corn ). Watch out: Tylosis could lead you down the wrong coding path if you re not careful. The ICD-9 index in the front of the coding book leads you to several options, such as (Other specified anomalies of skin; other; includes accessory skin tags, congenital; congenital scar; epidermolysis bullosa; keratoderma [congenital]), and this is the wrong path for a basic corn or callus. Your best bet when you encounter this term in the documentation is to ask the physician to clarify the condition. ICD-10: Once ICD-9 converts to ICD-10 in October, 2014, code 700 will no longer be valid. Instead, you would report ICD-10 code L84 (Corns and callosities). The deadline 2014 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC 27713

2 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Editorial Advisory Board Jean Acevedo, LHRM, CPC, CHC Senior Consultant Acevedo Consulting, Inc. Delray Beach, Fla. Arnold S. Beresh, DPM, CPC Certified, ABPS Fellow, ACFAS Peninsula Foot & Ankle Hampton, Va. Cathy Klein, LPN, CPC Director of Regional Network Services Cardinal Health Initiatives LLC Muncie, Ind. Janet McDiarmid, CMM, CPC, MPC CEO, McDiarmid Consultants LLC Past President, AAPC National Advisory Board Sylacauga, Ala. Richard Odom, DPM, CPC, AOPS Practicing Podiatrist Gulf Coast VA Hospital System Mobile, Ala. Daniel Waldman, DPM, FACFAS Blue Ridge Foot Centers, Asheville, NC President, Blue Ridge Podiatry Association, PA Hoda M. Henein, CHBME, CP President and CEO of Active Processing, Inc. Active Management College Point, NY for using ICD-10 is Oct. 1, 2014, with no grace period, stresses Pat Brooks, RHIA, senior technical advisor with the Centers for Medicare and Medicaid Services. Master the Definitions If you re still unsure about your physician s everyday description of these common conditions, learning the definitions of corn and callus will help. A corn is a small, horny area of the skin caused by local pressure (e.g., a shoe or hosiery) irritating the tissue over a bony prominence. Corns usually occur on a toe, where they form hard corns. Between the toes, pressure can form a soft corn of macerated skin, which often yellows. A callus is localized thickening and enlargement of the horny layer of the skin due to pressure or friction. Generally, calluses as well as corns can cause pain, and soft-tissue inflammation may occur around the base of the lesion. Knowing these definitions is also helpful if you plan to ask the physician for clarification. Example: You re struggling with how to code a patient diagnosis that describes a keratosis of the bottom of the great toe and the heel. You ve learned the synonyms for corns/calluses and remember that this is another name for a callus, but you notice that another nearby code has the same word in its descriptor: (Keratoderma, acquired; Keratosis [blennorrhagica]). You ask the physician for more details about the patient s condition so you can code it properly, and he describes a basic thickening of the skin because of bad shoes. Referring back to the definitions, now you know that it s just a callus and you can code it as 700. However: Keep in mind that claims using ICD 700 are rarely paid, especially by private insurance carriers, warns Arnold Beresh, DPM, CPC, CSFAC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. If the condition were keratosis blennorrhagica, the physician would have described a scaly rash that is associated with Reiter s syndrome, and this would tell you to code something other than 700, which is for a mere callus. But if a diagnosis brings you to the 701.x series (Other hypertrophic and atrophic conditions of skin), pay special attention to the definitions under each code. The definitions can help you verify whether the doctor is using the corn/callus term as a synonym or for a more specific description of the condition. Podiatry Coding & Billing Alert (USPS# ) (ISSN ) is published monthly 12 times per year by The Coding Institute - an Inhealthcare Company, The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute. All rights reserved. Subscription price is $299. Periodicals postage is paid at Durham, NC and additional entry offices. POSTMASTER: Send address changes to Podiatry Coding & Billing Alert, 4449 Easton Way, 2nd Floor, Columbus, OH, p2

3 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS CPT 2014 } : New E/M Codes Capture Doc Discussions Make sure to include a written report. Who knows if Medicare will pay, but you should be able to bill some payers for your podiatrist s interprofessional consultation services beginning Jan. 1, That s because CPT 2014 introduces four new codes that describe the work of two medical professionals who discuss a patient s condition via phone or Internet, as follows: Interprofessional telephone/internet assessment and management service provided by a consultative physician including a verbal and written report to the patient s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review minutes of medical consultative discussion and review minutes of medical consultative discussion and review minutes or more of medical consultative discussion and review. These codes make sense as more and more health plans allow for communication between physicians and patients via the internet. Codes appear to be in recognition of these situations. It affords the physician the ability to forward patient information (securely) to another physician for opinion and insight without having the patient come to all the different appointments, says Suzan Berman, MPM, CPC, CEMC, CEDC, manager of physician compliance auditing for West Penn Allegheny Health Systems, Pittsburgh, Pa. Check Who Reports and How These new codes are intended to be used only by the consultant physician, notes Kent Moore, senior manager for physician payment at the American Academy of Family Physicians. The patient s treating physician, which is typically the attending or primary care physician, who is seeking the consultant s opinion or advice with respect to diagnosis and/or management of the patient will not be able to use these codes for his or her portion of the conversation, Moore adds. The physicians will want to know if the codes are something they might be able to utilize, says Chandra L. Hines, practice supervisor of Wake Specialty Physicians in Raleigh, N.C. And it looks like the answer is yes when a primary care physician consults with a general surgeon in your practice, because the surgeon is the consultant. Write report: These new codes are effectively consultations, which means you must provide a written report to the requesting physician to qualify for the code. You ll see that requirement right in the code definitions, which state including a verbal and written report. Tick tock: Time distinguishes the four codes. I am a bit curious about why they are broken into time and how that time will be measured (reading, discussing, interpreting, further research, etc.). How will the time be documented? Berman asks. For any time-based codes, it would be expected that documentation includes the time component. Watch for Payment Medicare stopped paying for consultations in 2010, and much discussion followed about CPT eventually eliminating consultation codes. But here we are with four new consultation codes in Now the question becomes whether Medicare will recognize these codes. q E/M } Navigate the New-Versus-Established-Patient Maze With Expert Tips Different locations, same physician? Use established patient codes. When reporting many common E/M services, you must ask yourself two questions: First, is the patient new or established? And second, what are the documented levels of history, physical exam, and medical decision-making (MDM)? We ve got some quick tips on how to use this information to select the correct E/M level every time. (Continued on next page) p3

4 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Year Rule Determines Patient Status Generally, you should consider a patient to be established if any physician in your group (or, more precisely, any physician of the same specialty billing under the same group number) has seen that patient for a face-to-face service within the past 36 months, says Marvel Hammer, RN, CPC, CCS-P, PCS, ASC- PM, CHCO, owner of MJH Consulting in Denver, Co. For example: A patient complaining of skin rash comes to your office. Although this is provider A s first time meeting the patient, provider B, in the same group practice, saw the patient two years ago for a similar complaint. In this case, the patient is established. Don t let different locations lead you astray: If your practice has multiple locations, and a physician in location A sees the patient in January but a physician in location B sees the patient the following December, the patient is still established. The need to create a new chart is inconsequential, Hammer says. Non-face-to-face encounters don t count: A primary-care physician recommends that a 60-year-old female see the ophthalmologist regarding flashes and floaters. One of the physicians in your practice interpreted some test results for the same patient the previous year but provided no face-to-face service. In this case, you can still consider the patient to be new when selecting an initial E/M code because no physician within your practice provided the patient with a face-to-face service within the past three years. According to section of the Medicare Claims Processing Manual, An interpretation of a diagnostic test, reading an X-ray or EKG, etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient. Exceptions Could Occur for Different Specialties The new patient rule applies when physicians in the same practice are also of the same specialty. In a nutshell: If your practice is big enough and covers enough specialties, two physicians may see a patient for completely different reasons. This could allow you to report a new patient visit even though two physicians in the same practice saw the same patient within a three-year period if they are different specialties. Consult Codes Don t Differentiate The consult codes do not differentiate between new and established patients. Therefore, regardless of the patient s status, you should make your outpatient consult code choice from the range. When reporting consults and new patient E/M services, you ll need to meet the requirements of all three key components (history, exam and MDM) to report a given level of service. Shortcut: In effect, this means that whichever key component is the -lowest- will determine the E/M service level you choose, Hammer says. The AMA added text to CPT in 2006 to clarify that all of the key components (history, exam and MDM) must meet or exceed the stated requirements to qualify for a particular level of service for office, new patient ( ), hospital observation services ( ), initial hospital care ( ), office consultations ( ), initial inpatient consultations ( ) and others. 2 of 3 Will Do for Most Established E/M Visits When reporting most established patient outpatient E/M services (except consults and initial observation care, which do not distinguish new from established patients), you can assign an E/M level based on just two of the key components, Hammer says. Per CPT, you must meet or exceed the stated requirements for two of the three key components for established patient office visits ( ), subsequent hospital care ( ), subsequent nursing facility care ( ) and others. Watch for Overcoding Generally, medical necessity should determine the MDM level and, ultimately, the appropriate E/M service level. Physicians should not, for instance, report a comprehensive history and exam at every visit and expect to report 99215, regardless of medical necessity or the documented level of MDM. Simply stated: If the presenting problem won t support a highlevel E/M service, you can t get paid just because the physician documented a comprehensive history and exam. A final note: Remember, you may report E/M services based on time rather than the key components of history, exam and MDM if the physician spends more than 50 percent of the visit on counseling and/or coordination of care AND documents total time, percent (or time) spent for counseling/coordination of care and specific detail about the counseling/coordination of care. q p4

5 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS EHR Mythbuster } 3 EHR Myths That Could Cost Your Practice Heavily Warning: Blindly relying on your electronic system could mean payer audits. If you are using an electronic health records (EHR) system or contemplating adding it for your optometry practice, you also need to know the pitfalls of the system, such as inadequate documentation or unnecessary documentation, and how you can overcome them to get your hands on deserved reimbursement. Consider these three EHR myths to determine exactly where your EHR system could be leading you astray. Myth 1: Exam Documentation Will Carry Over for Follow-Up Visits If your EHR is producing documentation that is robust in one section (such as History) and thin in another (such as the Physical Examination), you may trust the device to do too much. A coder recently told the Coding Institute that an auditor downcoded most of her E/M claims due to an empty Physical Exam section in the documentation. However, the practice argued that the EHR vendor had told them that patients SPEcialty-SPEcific icd-10 webinars by industry experts AudioEducator provides the most economical and effective audio sessions on ICD-10. From the comfort of your office or home, learn what you need to navigate the new codes and master documentation requirements. And you can get answers to your top questions during the Q&A at the end of the session. Log on to and check out our upcoming and on-demand webinars for your specialty. You can also buy CD recordings and PDF transcripts. Call or to [email protected] for help! 2222 Sedwick Drive, Durham, NC Contact Us: being seen for established problems already have a physical examination documentation on file, and that the EHR will carry it over from one visit to the next. Reality: This may be true for past medical, family, and social history (PFSH), but not for a physical examination. E/M guidelines state that if a patient s PFSH has not changed since a prior visit, your provider does not need to document the information again, says Elizabeth Hollingshead, CPC, CUC, CMC, CMSCS, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio. He does, however, need to document that he reviewed the previous information to be sure it s up to date and also note in the present encounter s documentation the date of acquisition and location of the earlier PFSH. Some payers will give no PFSH credit if you overlook one of these two criteria. Good documentation: For instance, you can say, I reviewed the past, family, social history with the patient taken from today s patient questionnaire and our previous visit of June 1, She reports that nothing has changed since that date. Myth 2: EHR s Calculation of Time Spent Qualifies You to Code Based on Time One of the perks of electronic health records is that they typically record the date and time that you input information. In fact, many EHRs record a summary of the time spent on the You Be the Coder Diabetes Patient, Post-Amputation Question: A patient visited our clinic for a checkup for some ulcers on her right ankle. She had the toes on her right foot amputated six months ago due to gangrene. She has type II diabetes, peripheral vascular disease (PVD), and malignant hypertension. How should I code her condition? Delaware Subscriber Answer: See page 7. q (Continued on next page) p5

6 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC record at the bottom of each visit s documentation and give a total, such as Total time: 26 minutes, 15 seconds. Several coders have told the Coding Institute that they have used this time calculation to select an E/M code based on time alone. For example, if the EHR says that the time spent is 25 minutes, these practices are automatically reporting for the visits, using the rationale that CPT and Medicare guidelines allow you to code E/M services based on time alone. Reality: The key to billing based on time is that counseling and/ or coordination of care must dominate the visit, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPCH, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a consulting firm in Tinton Falls, N.J. Therefore, you can only select an E/M code using time as the controlling factor if you meet the rules, and an EHR s notation of time spent in the record will not meet those guidelines. Instead, to bill on time alone, your provider s documentation must contain the following three elements: Notation of the total time spent on the encounter, Notation of the total time spent on counseling and/or coordination of care or the percentage of the visit spent on counseling/care coordination, and A description of the counseling/care coordination. In an EHR, you may not know where to put such a statement, but most of these systems will have a radio button somewhere in the software that you can press to create a comment box. As long as you enter your statement about time as indicated above anywhere in the record for the encounter, you can code based on time alone, but simply stating the total time you spent or letting the EHR calculate it for you is not adequate. Reader Questions } Test Your ICD-10 Coding in March Question: I have heard that there will be a test period for using ICD-10 codes on claims before the October 1, 2014 implementation. When will that be? Connecticut Subscriber Answer: You ll get to test out your ICD-10 coding skills this spring with a dry run that CMS plans to offer practices who want to submit sample ICD-10 claims, CMS announced in MLN Matters article MM8465, published on Nov. 1. During the week of March 3 through March 7, 2014, your MAC will allow you to send in your test claims that include ICD-10 codes. If you have difficulty processing the claims, you ll be able to contact the help desk to figure out what went wrong. In addition, you will get electronic acknowledgement of Myth 3: You Should Use the EHR s Code Selection in Every Case Your electronic health record will most likely offer an E/M code suggestion at the end of each visit but that doesn t mean you should use that to justify all high-level codes. Several practices have told the Coding Institute that their providers thoroughly document the History and Physical Exam elements for all conditions whether the nature of the presenting problem requires such detailed documentation. This leads to the ability to report high-level codes, even if the medical decision making (MDM) and medical necessity of the encounter do not support or They justify this by pointing out that established patient office visits only require two out of three key components (History, Exam, MDM). However, keep in mind that the method of calculating MDM is not always consistent with medical necessity, Cobuzzi warns. Reality: CMS indicates in section of chapter 12 of its Medicare Claims Processing Manual that Medical necessity is the overarching criterion for payment in addition to the individual requirements of a CPT code. In addition, the 1995 and 1997 E/M Documentation Guidelines state, The documentation of each patient encounter should include: reason for the encounter and relevant history, physical examination findings and prior diagnostic test results. Therefore, you should use your EHR s code selection only as a suggestion, but the final code choice should be up to the clinician, and should be based on medical necessity and the nature of the presenting problem as well as the other key components of the service. your test claims that will tell you whether they were accepted or rejected. After the testing period ends, CMS will share information about the percentage of test claims that were accepted versus rejected, and will offer additional information about lessons learned during the testing period. To read more about the ICD-10 test dates, visit Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM8465.pdf. q Know How to Without Violating HIPAA Question: I sometimes patient records to consultants for help on how to bill. How can I make sure I m not committing a HIPAA violation? Connecticut Subscriber p6

7 Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC The Coding Institute SPECIALTY ALERTS Answer: A simple request for help can land you in plenty of trouble with HIPAA. The key is to remove all identifying information from the report before you send it. Here s how: Under HIPAA s Privacy Rule, you have to make sure you don t send protected health information (PHI) by removing all individually identifiable health information, including health information that reasonably allows individual identification. In general, HIPAA is based on reasonableness. Best bet: Only send the portions of the report that describe the clinical procedure and findings, and include a confidentiality notice at the end of your . This guideline applies whether you send the from an office or from home. Specifics: Before you send the report by , remove the patient s name and Social Security number. You should also remove geographic identifiers, dates, phone, fax, and You Be the Coder Diabetes Patient, Post-Amputation Answer: For your patient, code: (Question on page 5) (Peripheral angiopathy in diseases classified elsewhere) (Diabetes with peripheral circulatory disorders; type II or unspecified type, not stated as uncontrolled) V49.73 (Lower limb amputation status; foot) (Essential hypertension; malignant). Use V49.73 to identify the specific amputation site. You should use the V49.6x and V49.7x codes only to report acquired amputation status due to trauma or surgical amputation due to disease. For the hypertension, list for this patient. Don t list a code for gangrene because it s no longer present. The PVD, however, is likely to continue to be a problem, so listing is appropriate. Note: ICD-9 assumes the gangrene is a consequence of a diabetic peripheral vascular circulatory disorder. This is usually true when the gangrene is of the lower extremity. If there is no other stated cause, gangrene is considered a manifestation of diabetes. q information, and medical record and device serial numbers. Then you read through the report before you send it to be sure you can reasonably assume the patient is no longer identifiable. Experts advise that for extra security, you send an encrypted to keep information safe. q Opt for First-Initial, Last-Name Privacy Protocol Question: What guidelines should our group follow to protect the privacy of patient information in public areas? For example, we keep our charts in a rack visible to visitors who enter our office. The charts show the patient s name and physician s name; no testing or code indicators are visible. South Carolina Subscriber Answer: You re definitely on the right track because you aren t disclosing code or testing information. But there are even more steps you can take to ensure your patients privacy. Step 1: Explore the option of moving the chart rack to an area that is not visible to all the visitors entering your office. Step 2: Consider not including the physician s name on charts that could be visible to visitors. Step 3: Instead of using a patient s full name, use her first initial and last name (or first initial and only the first few letters of the patient s last name). This works on several levels. First, it doesn t pose a patient identity risk because it s rare that there would be two patients with the same first initial and last name in the same room. This process also meets The Joint Commission s Standard IM.2.10 specifically, to maintain patient privacy. Although The Joint Commission doesn t specifically address patient privacy, your state and federal regulations do. And The Joint Commission does require organizations to be compliant with state and federal laws and regulations. Another benefit to noting the patient s name this way is that the patient s gender remains undisclosed, which provides even greater security as a passer-by would know even less about the patient. Trap: If your organization used first name and last initial, there would be a greater likelihood of having two people with the same first name and last initial in the same room. The same problem would occur if you used first initial and last initial. q Answers to You Be the Coder and Reader Questions were reviewed by Arnold Beresh, DPM, CPC, CSFAC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va. p7

8 The Coding Institute SPECIALTY ALERTS Call us: The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC AVOID AUDITS.IMPROVE REIMBURSEMENT.REDUCE DENIALS.INCREASE REVENUE Podiatry C O D I N G A L E R T We would love to hear from you. Please send your comments, questions, tips, cases, and suggestions for articles related to Podiatry Coding & Billing Alert to the Editor indicated below. Jerry Salley, CPC [email protected] Editor Arnold Beresh, DPM, CPC Consulting Editor Mary Compton, PhD, CPC [email protected] Editorial Director & Publisher The Coding Institute LLC, 2222 Sedwick Drive, Durham, NC Tel: Fax: [email protected] Podiatry Coding & Billing Alert is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. If legal advice or other expert assistance is required, the services of a competent professional should be sought. CPT codes, descriptions, and material only are copyright 2013 American Medical Association. All rights reserved. No fee schedules, basic units, relative value units, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. Rates: USA: 1 year, $299. Bulk pricing available upon request. Contact Medallion Specialist Team at [email protected]. All major credit cards accepted. This publication has the prior approval of the American Academy of Professional Coders for 0.5 Continuing Education Units. Granting of this approval in no way constitutes endorsement by the Academy of the content. To access each issue s CEU quiz, visit Supercoder.com/ceus and then login. To request login information, [email protected] The CEU is valid for 1 year from issue s month. Anesthesia Cardiology Dermatology Emergency Medicine Family Medicine Gastroenterology General Surgery Health Information Compliance ICD-10 Coding Internal Medicine Neurology & Pain Management Neurosurgery Jennifer Godreau, CPC, CPMA, CPEDC [email protected] Director of Development & Operations The Coding Institute also publishes the following specialty content both online and in print. Call for a free sample of any or all of the specialties below: Ob-Gyn Oncology & Hematology Ophthalmology Optometry Coding and Billing Orthopedics Otolaryngology Part B (Multispecialty) Pediatrics Physical Medicine & Rehabilitation Podiatry Practice Management Psychiatry Pulmonology Radiology Rehab Report Urology Call us ( ) and mention your customer number for a special price, free trial, or just to find out more about SuperCoder the complete online medical coding solution. Order or Renew Your Subscription! Yes! Start/Renew my one-year subscription (12 issues) to Podiatry Coding & Billing Alert Print & Online - $399 (Special Renewal price for active subscribers - $299 only!) Print only - $299 Online only - $199 Name Title Company Address City, State, ZIP Phone Fax * Must provide address if you choose online or both option to receive issue notifications To help us serve you better, please provide all requested information Payment Options Charge my: MasterCard VISA AMEX Discover Card # Exp. Date: / / Signature: Check enclosed (Payable to The Coding Institute) Bill me (please add $15 processing fee for all bill me orders) Podiatry Coding & Billing Alert The Coding Institute PO Box Atlanta, GA Call Fax [email protected] Promo Code: PC3RAA01 Also Access Your Alert Online at p8