Podiatry Coding & Billing Alert

Question: When a patient comes in for diabetic footcare, is it required for the podiatrist to document in their note who the patient’s primary care provider (PCP) is and the date the patient was last seen by that PCP?

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Answer: Medicare requires that the patient be under the care and supervision of a medical provider who is treating the diabetes to qualify for routine foot care such as the treatment of nails and calluses. For that reason, your podiatrist’s note needs to document the name of the patient’s PCP and the date the PCP last saw the patient, even if the date is an approximate one.

Most private payers do not require this information, but many Medicare jurisdictions do require it on the claim for those with diabetes. So, it’s best to get into the habit of collecting the information.

Practice management tip: The most efficient way to obtain this information is when the patient is taken to the exam room. The podiatry assistant should be collecting this information from the patient and either entering it into the encounter note, or giving it to the podiatrist to enter.