Podiatry Coding & Billing Alert

Hint: You must bill G0247 on same date of service with either G0245 or G0246.

If you have ever wondered how to appropriately bill diagnosis and treatment of peripheral neuropathy with loss of protective sensation (LOPS) in diabetic patients, then you’ve come to the right place. Take the following quiz to learn all you need to know about billing for these special services.

Don’t miss: You can find the specific guidelines for billing for the diagnosis and treatment of peripheral neuropathy with LOPS in diabetic patients in chapter 32, section 80 of the Medicare Claims Processing Manual.

First, Define Peripheral Neuropathy With LOPS

Question 1: What is peripheral neuropathy with LOPS and how does it relate to a patient’s feet?

Answer 1:  Peripheral neuropathy is known as the most common factor leading to amputation in diabetic patients, according to the manual.

“In diabetes, peripheral neuropathy is an anatomically diffuse process primarily affecting sensory and autonomic fibers; however, distal motor findings may be present in advanced cases,” the manual continues. “Long nerves are affected first, with symptoms typically beginning insidiously in the toes and then advancing proximally.”

This, then, leads to LOPS, where a patient can’t feel minor trauma from mechanical, thermal, or chemical sources. “When foot lesions are present, the reduction in autonomic nerve functions may also inhibit wound healing,” the manual adds.

Bottom line: Peripheral neuropathy with LOPS, secondary to diabetes, is then defined as “a localized illness of the feet and falls with the regulation’s exception to the general exclusionary rule (see 42 C.F.R. §411.15(l)(l)(i)),” via the manual.

Foot Exams Covered For Patients With Diabetic Peripheral Neuropathy With LOPS

Question 2: Are foot exams for patients with diabetic peripheral neuropathy with LOPS covered under Medicare?

Answer 2: Yes. According to the manual, foot exams for patients who have diabetic neuropathy with LOPS are considered “reasonable and necessary to allow for early intervention in serious complications that typically afflict diabetics with the disease.”

Keep This Exam Time Limit in Mind

Question 3: What is the time limit for the coverage of exams for patients with diabetic sensory neuropathy and LOPS?

Answer 3: For services furnished on or after July 1, 2002, Medicare will cover a foot exam and treatment of patients who have a documented diagnosis of diabetic sensory neuropathy and LOPS, no more often than every six months.

Exception: The manual does stipulate that the patient can have the foot exam no more often than every six months, as long as he “has not seen a foot care specialist for some other reason in the interim.”

Make Sure LOPS Diagnosed Through These Means, Documented Appropriately

Question 4: How is LOPS diagnosed?

Answer 4: Podiatrists diagnose LOPS through sensory testing with the 5.07 monofilament using established guidelines, like the National Institute of Diabetes and Digestive and Kidney Diseases guidelines, according to the manual.

The podiatrist should test five sites on the plantar surface of each foot, per the National Institute’s guidelines. “The areas must be tested randomly since the loss of protective sensation may be patchy in distribution, and the patient may get clues if the test is done rhythmically,” the guidelines add.

Don’t miss: “Heavily callused areas should be avoided,” per the guidelines. “As suggested by the American Podiatric Medicine Association, an absence of sensation at two or more sites out of five tested on either foot when tested with the 5.07 Semmes-Weinstein monofilament must be present and documented to diagnose peripheral neuropathy with loss of protective sensation.”

Caution: The podiatrist must document how he determined the neuropathy was determined, for example Symes-Weinstein 5.07 monofilament or by EMG physiologic testing, etc., confirms Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan.

Look To These HCPCS Codes for Diabetic Neuropathy And LOPS

Question 5: Which HCPCS codes do you have to choose from when it comes to your diabetic neuropathy with LOPS claims?

Answer 5: Your applicable HCPCS codes are as follows:

• 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: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education)
• 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: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education)
• 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)

As you can see from the code descriptors, you would bill G0245 for an initial foot exam for a diabetic patient with LOPS. Then, you would bill G0246 for a follow-up evaluation of a diabetic patient with LOPS. Lastly, you should use G0247 for routine footcare for a diabetic patient with LOPS.

Don’t miss: You must bill G0247 on the same date of service with either G0245 or G0246 to be considered for payment.

Always Include These ICD-10 On Diabetic Neuropathy With LOPS Claims

Question 6: Which diagnosis codes should you report on diabetic neuropathy with LOPS claims?

Answer 6: The podiatrist must document one of the following diagnosis codes for diabetic neuropathy with LOPS claims:

• E08.40 (Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified)
• E08.42 (Diabetes mellitus due to underlying condition with diabetic polyneuropathy)
• E09.40 (Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified)
• E09.42 (Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy)
• E10.40 (Type 1 diabetes mellitus with diabetic neuropathy, unspecified) through E10.49 (Type 1 diabetes mellitus with other diabetic neurological complication)
• E10.610 (Type 1 diabetes mellitus with diabetic neuropathic arthropathy)
• E11.40 (Type 2 diabetes mellitus with diabetic neuropathy, unspecified) through E11.49 (Type 2 diabetes mellitus with other diabetic neurological complication)
• E11.610 (Type 2 diabetes mellitus with diabetic neuropathic arthropathy)
• E13.40 (Other specified diabetes mellitus with diabetic neuropathy, unspecified) through E13.49 (Other specified diabetes mellitus with other diabetic neurological complication)
• E13.610 (Other specified diabetes mellitus with diabetic neuropathic arthropathy).