Podiatry Coding & Billing Alert

Question: My co-worker tells me that you can never report G0247 by itself, is this true?

Maine Subscriber

Answer: Yes. 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) is not a stand-alone code. You must report G0247 on the same date of service with either:

• G0245 -- Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include ..., or
• G0246 -- Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include at least the following ...

Modifier: You need to 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 or G0246 when you bill them with G0247. Modifier 25 tells your payer that the podiatrist performed the routine foot care separate from the E/M service he also performed on the same day.

Example: Your podiatrist sees a new patient suffering from peripheral neuropathy (337.xx) with LOPS. The patient complains of a painful toe. Upon examination, your podiatrist discovers that the patient has overgrown toenails and decides to trim the patient's nails. For this procedure, you should report G0245-25 for the exam for peripheral neuropath and G0247 for the nail trimming.