Follow the Guidelines for Diabetic Foot Care Coding

New guidelines for diabetic foot care, foot care, podiatry coding, new diabetes guidelines, foot care coding

With the susceptibility diabetics have for losing feeling in their feet — a condition called loss of protective sensation, or LOPS — good foot care is vital for people with diabetes. When people develop diabetic sensory neuropathy and LOPS, they may be unable to feel when a stone gets lodged in their shoe, or if they step on glass, or burn their feet on hot pavement. With the poor wound healing that is inherent to diabetes, situations like this can quickly turn disastrous. For this reason, Medicare and many other payers cover special diabetic foot examination and treatment every six months for people who have documented diabetic sensory neuropathy and LOPS. Here are some tips for success with reporting diabetic foot care.

Choose the Correct Procedure Codes

Some of the services that Medicare will cover for diabetics diagnosed with sensory neuropathy and LOPS include cutting or removal of corns and calluses; nail trimming, cutting, or debriding; and preventive maintenance foot care. These can be performed in the office, in an outpatient setting, or in the patient’s home.

You can choose from among several HCPCS G codes to report these services.

  • G0245, Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

Report G0245 the first time a diabetic patient sees your provider. You’ll use this code to report routine foot care for patients who have diabetes and a documented loss of sensation but who have adequate circulation.

  • G0246, Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

When an established diabetic patient comes in for follow-up care, you may report G0246.

  • G0247, Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)…

You can report G0247 when your provider performs any allowed routine foot care procedure as discussed earlier. Code G0247 must be billed on the same date of service with either G0245 or G0246 in order to be considered for payment.

  • G0127, Trimming of dystrophic nails, any number.

Report this code for routine nail care for established diabetic patients.

Watch Your CCI Edits!

CMS’s National Correct Coding Initiative (CCI) edits consider G0245 to be a part of an E/M code. For this reason, you can’t claim reimbursement for both G0245 and an office or outpatient E/M code (99201-99215) for the same date of service, as they are bundled together. Since you have to choose one or the other, you might be best off with billing the G0245 and skip the E/M code for that visit, depending on what the E/M code involves, of course.

Meet Documentation Requirements

The medical record must include the patient’s past medical history of diabetic neuropathy, and the physical examination documentation should include all of the following items:

  • Visual inspection of forefoot, hind foot, and 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
  • Education of patient on diabetic foot care.

How About You?

Have you had special success (or particular trials) with coding for diabetic foot care? Let us know in the comment box below.

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About 

Susan taught health information and healthcare documentation at the community college level for more than 20 years. She has a special love for medical language and terminology. She is passionate about ensuring accurate patient healthcare documentation through education. She has a master's degree in healthcare administration, is a certified healthcare documentation specialist, and serves as immediate past president for the Association for Healthcare Documentation Integrity (AHDI).

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