Primary Care Coding Alert

Swift payment might be as easy as switching your diabetes fourth digit To get diabetic peripheral neuropathy foot care claims paid the first time around, you-ve got to nail down Medicare's required diagnoses for this condition. Test your savvy with the following claim typical of ones that family physician practices have been trying to get paid and Medicare carriers have been denying. A common submission contains: - 99213-25 with diagnosis of back pain and hypertension - G0245 (foot exam) with diagnosis code 250.70. 1. Adhere to Unbreakable Bundle To avoid denial, you should report only the office visit: 99213-25 (Office or other outpatient visit for the evaluation and management of an established patient -; Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service). -Medicare will not pay for a foot exam (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 - or G0246, Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] -) with an E/M code with any modifier according to CCI edits,- Mary Ann Fanning, coding supervisor for East Tennessee Medical Group in Alcoa. -I checked CCI edits and the two codes cannot be billed using any modifier " the only payable code is G0247 (Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] -),- Fanning reports. -The edit makes sense,- notes Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians in Leawood, Ks. The foot exam is basically an evaluation and management service. So if the physician is otherwise doing an E/M service, the work associated with the foot exam should probably be considered part of the E/M service, which is how the CCI edits are structured, he explains. 2. Find Out Medicare's Covered G0245 Diagnoses Let's suppose instead of treating the patient for back pain, hypertension, and an initial foot exam, the FP in our case study provided only the foot exam. You-ll keep getting denials for initial foot evaluations of Medicare beneficiaries unless you use your carrier's allowed ICD-9 codes. In the E/M-25 foot exam denial example, "they used the incorrect diagnosis code for billing G0245," says Melanie Witt, RN, CPC-OBGYN, MA, a coding consultant in Guadalupita, N.M. The foot exam requires 250.6x (Diabetes with neurological manifestations), not 250.7x (Diabetes with peripheral circulatory disorders). The G code is designed to help cover routine foot care for patients who have [...]