Podiatry Coding & Billing Alert

Question: My podiatrist sees a new patient suffering from peripheral neuropathy with LOPS. The patient complains of a painful toe. Upon examination, the podiatrist discovers that the patient has overgrown toenails and decides to trim the patient's nails. How should I report it?

Answer: For this procedure, you should report G0245 and G0247. Additionally, you should 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 (Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]...) or G0246 (Followup physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]...) when you bill them with G0247. This tells your payer that the podiatrist performed the routine foot care separate from the E/M service he also performed on the same day.

G0247 is not a stand-alone code. If you failed to report the code on the same date of service with either G0245 or G0246, payers will deny your claim.