Podiatry Coding & Billing Alert

Question: I'm aware of Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS). Nonetheless, I'm not sure how I should use the related G codes. Could you enlighten me?

Florida Subscriber

Answer: Sure. First, the G codes you are referring to are G0245 (Initial physician Evaluation and Management [E/M] of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] ...), and G0246 (Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] ...). You'll use G0245 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.

Meanwhile, you'll choose G0246 for a diabetic patient's follow-up visit with your podiatrist.

Just as important is the documentation that should be in the podiatrist's note when you use G0245 or G0246. Make sure the medical record contains the patient's medical history that indicates he has diabetic neuropathy. Documentation should include:

• 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.

Warning: 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.

Answers to You Be the Coder and Reader Questions were reviewed by Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.