Podiatry Coding & Billing Alert

When you prepare claims for mycotic nail debridement, your carrier may specify that it prefers G0247 instead of CPT 11720 and CPT 11721 in diabetic neuropathy cases. For example, if a physician treats symptomatic mycotic nails on a patient with diabetic sensory neuropathy, carrier Palmetto GBA says in its LCD that its providers should report G0247 (Routine foot care by a physician of a diabetic patient ...). Be sure to note whether your carrier prefers CPT or HCPCS codes when reporting this procedure.

Careful: If you must report the G code, you have special guidelines to follow, according to CMS's Routine Foot Care/Mycotic Nail Debridement information. Included in these guidelines are the following pointers:

• Report G0247 only in conjunction with either G0245 (Initial physician evaluation and management of a diabetic patient ...) or G0246 (Follow-up physician evaluation and management of a diabetic patient ...) -- never alone.

• Use G0247 for routine foot care of a patient with diabetic sensory neuropathy resulting in a loss of protective sensation and who does not meet class findings requirements.

• Know that Medicare limits G0245, G0246 and G0247 coverage to when you report 250.60-250.63 (Diabetes with neurological manifestations) and 357.2 (Polyneuropathy in diabetes).

In addition, each physician or physician group may only collect payment for G0245 once for each beneficiary. If that beneficiary must see a new physician, that new physician may also receive payment (once) for G0245 as long as six months have passed since the last time the carrier paid G0245 or G0246, regardless of who provided the service.

Similarly, you can only use G0247 every six months and only if no other foot care occurred during that time.

Note: For more about foot care, see the Medicare program memorandum at www.cms.hhs.gov/transmittals/downloads/ab02158.pdf.