Podiatry Coding & Billing Alert

Question: What code should I report for an initial diabetic foot exam for a Medicare patient?

Answer: You should report G0245 (Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]...) for initial diabetic foot examinations for Medicare patients.

Caution: The complete code descriptor for G0245 contains a number of stipulations your podiatrist will have to meet upon first meeting the patient: a LOPS diagnosis; a patient history; patient education; and “a physical examination that consists of at least the following elements,” per the code’s descriptor:

• Visual inspection of the forefoot, hindfoot, and toe web spaces
• Evaluation of a protective sensation
• Evaluation of foot structure and biomechanics
• Evaluation of vascular status and skin integrity
• Evaluation and recommendation of footwear

Don’t miss: You should report a follow-up diabetic foot exam with G0246 (Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS]...). This code includes the same above stipulations as G0245.

Per Medicare guidelines, patients with diabetic peripheral neuropathy and LOPS may have their feet examined “every 6 months … as long as [they] haven’t seen a foot care professional for another reason between visits” (Source: www.medicare.gov/coverage/foot-care-for-diabetes).