Podiatry Coding & Billing Alert

Question: I understand that both G0247 and CPT 11720 -CPT 11721 apply to mycotic nail debridement. How do I decide which one goes with my claim?

Wisconsin Subscriber

Answer: The carrier should specify that it prefers G0247 (Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [lops] to include, the local care of superficial wounds [i.e. superficial to muscle and fascia] and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails), instead of 11720 (Debridements of nail[s] by any method[s]; 1 to 5) and 11721 (Debridements of nail[s] by any method[s]; 6 or more) in diabetic neuropathy cases.

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 collect payment for G0245 only 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 use G0247 only every six months and only if no other foot care occurred during that time.