Primary Care Coding Alert

Edits, not diagnosis, trigger case study denial. If your FP provides an office visit and an initial foot exam for a LOPS patient, you should include G0245 in the E/M service or Medicare will deny the foot care. -Avert Foot Exam Denials in 1, 2, 3 Steps- in Family Practice Coding Alert 2008 Vol.11, No.1, incorrectly attributed denials for 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 ...) with 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 the procedure or other service) to the subscriber using the wrong diabetes fourth digit. Problem: -Medicare will not pay for a foot exam (G0245 or G0246, Follow-up [...]