Podiatry Coding & Billing Alert

Capturing payment for routine foot care can be a challenge for podiatry practices -- but if you know the answers to three frequently asked questions (FAQs), you'll take the guesswork out of coding your diabetic neuropathy care claims.

Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS) have been in force since 2002. Yet many still find the related G codes confusing. Understanding what each of the codes covers and how to use the codes will help you avoid denials and lost reimbursement.

Medicare provides routine foot care coverage for diabetic patients diagnosed with sensory neuropathy and LOPS. You will report these services using three HCPCS G codes:

• G0245 (Initial physician Evaluation and Management (E/M) of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) ...) -- You'll use this code when a patient sees your podiatrist for the first time. This G code represents routine foot care for patients who have adequate circulation and diabetes, but who also have a documented loss of sensation.

• G0246 (Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) ...) -- You will use this code for a diabetic patient's follow-up visit with your podiatrist.

• G0247 (Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) ...) -- Use this code when your podiatrist performs any routine care procedure, such as the local care of superficial wounds, debridement of corns and calluses, or trimming and debridement of nails.

A routine foot care local coverage determination (LCD) from Trailblazer offers guidance about these three G codes, points out Richard D. Odom, DPM, CPC, a podiatrist in Spanish Fort, Ala. "HCPCS codes G0245, G0246 and G0247 have been developed for reporting these physician services under Medicare coverage," according to the LCD, which you can find

at www.trailblazerhealth.com/Tools/LCDs.aspx?DomainID=1&ID=3271. "Codes G0245 and G0246 have been revised to describe them more accurately as E/M services."

What's different: "The whole issue of routine foot care has changed dramatically since Medicare changed rules for reimbursement," said John Bishop, PA-C, CPC, MS, CWS, president of Bishop and Associates, a physician coding, compliance, and reimbursement consulting company in Tampa, Fla. Where before you were allowed to charge for individual foot care procedures for diabetics, now such procedures are bunched together under this trio of G codes specifically for diabetics with LOPS, Bishop added.

No. G0247 is not a stand-alone code. Bishop emphasizes that you must report G0247 on the same date of service with either G0245 or G0246. Payers will deny your claim otherwise.

Modifier help: You need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to G0245 or G0246 when you bill them with G0247. Modifier 25 tells your payer that the podiatrist performed the routine foot care separate from the E/M service he also performed on the same day.

Example: Your podiatrist sees a new patient suffering from peripheral neuropathy with LOPS. The patient complains of a painful toe. Upon examination, your podiatrist discovers that the patient has overgrown toenails and decides to trim the patient's nails. For this procedure, you should report G0245-25 and G0247.

If your payer decides to audit your diabetic neuropathy routine foot care claims, you may end up having to pay back a portion of your reimbursement if the podiatrist's documentation doesn't meet certain documentation requirements.

To avoid auditing issues, make sure that the medical record contains the patient's medical history that indicates he has diabetic neuropathy. Your podiatrist's documentation of the physical examination should include all of the following:

• Visual inspection of forefoot and hind foot (including toe web spaces)

• Evaluation of protective sensation

• Evaluation of foot structure and biomechanics

• Evaluation of vascular status and skin integrity

• Evaluation of the need for special footwear

• Patient education.

Don't overlook: Be sure your practice documents in the patient's chart which MD or DO certified the "systemic condition." Your podiatrist should also be sure to document the date of the patient's most recent visit with a physician for foot care within the last six months, according to Paul Fehring, owner of Drs. Central Billing, a podiatry-only billing company based in Fairfield, Ohio.

Here's why: Medicare coverage entitles individuals with a documented diagnosis of diabetic sensory neuropathy and LOPS to an evaluation and treatment of the feet once every six months for as long as the patient has not seen a foot care specialist in the interim, according to the routine foot care LCD from Trailblazer. Codes G0245-G0247 refer to any foot care by any type of physician, not only podiatrists. Make sure that your podiatrist asks the patient if he has received any type of foot care in the past six months. If the patient isn't sure, have him sign an advance beneficiary notice (ABN) before providing care.

An ABN is a written notice you should give to a Medicare patient before providing services when you expect Medicare won't pay for some or all of the service, according to the Trailblazer ABN Manual. (You can find the LCD online at www.trailblazerhealth.com/Publications/Training%20Manual/abn.pdf.) The ABN proves that you let the patient know prior to the service that Medicare might not pay and you may bill him directly.