I asked this on another forum:
Provider performs a comprehensive yearly diabetic foot exam, along with nail and callus debridement. As long as documentation supports this e/m is separate from the procedures, is this okay to bill out? I cannot find anything that says otherwise.
Example:
99213-25
11056
11720-59
I was advised this was okay. Now I'm finding other documentation that it is not okay to bill as an E/M service, as there is no real chief complaint other than they are diabetic and due for yearly exam. Some of what I've read states that this exam is considered inclusive in the foot care, unless another problem is addressed to justify the E/M.
We are just now seeing this as an issue, as no other problems are being discussed at the same encounter to support the E/M (there was always another reason the pt was being seen). Now, they are just scheduled for routine foot care and she is deciding to do their yearly at the same visit.
Most of these patients have Medicare, and most are diabetic patients that are dx'd as 250.60/LOPS. Our previous provider did not care to bill for the G0245/6/7 codes, but I think if our new provider wants to start making sure these bi-yearly exams are done, without anything other dx to support an E/M, so it looks like we are going to have to bill these G codes.
Would everyone agree?
The reimbursement looks to be less, and I cannot find any rules regarding this billing - which is why I'm wondering why anyone would use HCPCS, when Medicare will pay for the CPTs..
1. If this is the case (billing the G codes) - do we HAVE to bill the G0247 in conjunction with the G0245/6? Or could we use the other cpt codes in conjunction with a G0246? (1172X,1105X,97597)
2. Is this coding example below correct? No idea for these G codes..
Estb pt with 250.60 comes in with c/o blister ? new problem/workup, etc. Upon debridement-ulcer to full depth, bill : 9921X-25 with G0247 (wound care debridement - instead of 97597? This scenario doesn't seem right..
3. What about pts that have covered diabetic conditions, other than neuro, and need their yearly CDFE done - when scheduled with foot care? Can't bill e/m right? So this is included in foot care?
4. Provider insists that since pt was dx'd by PCP with 250.60/LOPS that she can bill for nail care to Medicare with 250.60, even though in her exam - there was no missed sensation. I disagree - thoughts?
5. When documenting missed sensation, our previous provider would state
"x/5 areas when tested missed sensation" (2 or more). Our new provider will document "several areas missed sensation.." or "Protective sensation when tested with Semmes Weinstein 5.07 monofilament significantly absent in multiple areas, 4 toes each foot". Is this sufficient?
Thank you
Provider performs a comprehensive yearly diabetic foot exam, along with nail and callus debridement. As long as documentation supports this e/m is separate from the procedures, is this okay to bill out? I cannot find anything that says otherwise.
Example:
99213-25
11056
11720-59
I was advised this was okay. Now I'm finding other documentation that it is not okay to bill as an E/M service, as there is no real chief complaint other than they are diabetic and due for yearly exam. Some of what I've read states that this exam is considered inclusive in the foot care, unless another problem is addressed to justify the E/M.
We are just now seeing this as an issue, as no other problems are being discussed at the same encounter to support the E/M (there was always another reason the pt was being seen). Now, they are just scheduled for routine foot care and she is deciding to do their yearly at the same visit.
Most of these patients have Medicare, and most are diabetic patients that are dx'd as 250.60/LOPS. Our previous provider did not care to bill for the G0245/6/7 codes, but I think if our new provider wants to start making sure these bi-yearly exams are done, without anything other dx to support an E/M, so it looks like we are going to have to bill these G codes.
Would everyone agree?
The reimbursement looks to be less, and I cannot find any rules regarding this billing - which is why I'm wondering why anyone would use HCPCS, when Medicare will pay for the CPTs..
1. If this is the case (billing the G codes) - do we HAVE to bill the G0247 in conjunction with the G0245/6? Or could we use the other cpt codes in conjunction with a G0246? (1172X,1105X,97597)
2. Is this coding example below correct? No idea for these G codes..
Estb pt with 250.60 comes in with c/o blister ? new problem/workup, etc. Upon debridement-ulcer to full depth, bill : 9921X-25 with G0247 (wound care debridement - instead of 97597? This scenario doesn't seem right..
3. What about pts that have covered diabetic conditions, other than neuro, and need their yearly CDFE done - when scheduled with foot care? Can't bill e/m right? So this is included in foot care?
4. Provider insists that since pt was dx'd by PCP with 250.60/LOPS that she can bill for nail care to Medicare with 250.60, even though in her exam - there was no missed sensation. I disagree - thoughts?
5. When documenting missed sensation, our previous provider would state
"x/5 areas when tested missed sensation" (2 or more). Our new provider will document "several areas missed sensation.." or "Protective sensation when tested with Semmes Weinstein 5.07 monofilament significantly absent in multiple areas, 4 toes each foot". Is this sufficient?
Thank you
