Podiatry Coding & Billing Alert

Question: My podiatrist sees a lot of patients with diabetes mellitus. Would it be appropriate to code 2028F along with G0245 for their initial visit?

Alabama Subscriber

Answer: No. The Centers for Medicare and Medicaid Services (CMS) considers G0245 (Initial physician evaluation and management [E/M] of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] which must include:...) to be an E/M code. You report 2028F (Foot examination performed [includes examination through visual inspection, sensory exam with monofilament, and pulse exam - report when any of the 3 components are completed]) for routine foot care exam. The Correct Coding Initiatives (CCI) edits consider G0245 to be a component of E/M, which means that reimbursement for G0245 is included in the office visit code (99201-99215) reimbursement when both the exam and the visit are billed on the same date of service. Therefore, you cannot bill these codes together. 

Also, these two services should not be billed on the same date of service because the diagnosis of diabetic sensory neuropathy resulting in a LOPS should be established and documented prior to coverage of foot care. LOPS should be diagnosed through sensory testing with a 5.07 monofilament. Once the diagnosis is established, CMS will pay a physician or group practice once for G0245. If the patient must see a new physician, however, the new physician may bill for G0245 if neither G0245 nor G0246 (Follow-up physician E/M of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]...) has been billed for that patient in the previous 6 months. Bill ICD-9 diagnosis code 250.xx plus an additional diagnosis code for the specific manifestations, per CMS.