Neurology & Pain Management Coding Alert

Question: A recent Medicare program memo addressed the treatment and diagnosis of diabetic patients with loss of protective sensation (LOPS). How are we to be reimbursed for this service? Neurology Discussion Group Participant Answer: According to Medicare Coverage Policy, National Coverage Determination #CAG-0059N, Medicare will extend coverage to include services normally deemed routine "for beneficiaries with a systemic condition(s) that results in severe circulatory embarrassment or areas of diminished sensation in the individual's legs or feet." Specifically, the policy states, "Foot exams for people with diabetic peripheral neuropathy with LOPS are reasonable and necessary because of their potential role in early intervention of the serious complications that typically afflict diabetics with the disease." Coverage began July 1, 2002. Foot disease due to ulcerations and other lower-extremity complications is the most common diabetic complication leading to hospitalization, and peripheral neuropathy is the most important factor resulting in amputation. Peripheral neuropathy affects sensory and autonomic fibers, with occasional distal motor findings in advanced cases. Symptoms manifest first in the toes and advance up the leg, which can result in LOPS whereby the patient is unable to feel minor trauma from mechanical, thermal or chemical sources. According to CMS figures, about 70 percent of diabetics develop neuropathy within five years of diagnosis. After five years, the incidence increases to almost 100 percent. To track and reimburse services related to foot care of LOPS patients, CMS has created three new HCPCS codes: G0245 (Initial physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]), G0246 (Follow-up evaluation ...) and G0247 (Routine foot care ...). Although podiatrists will provide many of these services, according to Medicare guidelines, "Services may be furnished and billed by any Medicare provider licensed to provide such services."

Requirements to report G0245 include:

the diagnosis of LOPS a patient history
a physical examination that consists of at least: - visual inspection of the forefoot, hindfoot, and toe web spaces - evaluation of a protective sensation - evaluation of foot structure and biomechanics - evaluation of vascular status and skin integrity - evaluation and recommendation of footwear

patient education. Requirements for G0246 include:
a patient history
a physical examination that includes:
- visual inspection of the forefoot, hindfoot, and toe web spaces
- evaluation of protective sensation
- evaluation of foot structure and biomechanics
- evaluation of vascular status and skin integrity
- evaluation and recommendation of footwear
patient education. Requirements for G0247 include:
local care of superficial wounds debridement of corns and calluses trimming and debridement of nails. Note: Code G0247 must be billed with either G0245 or G0246 to be considered for payment. The diagnosis of peripheral [...]