Question Diabetic foot exams

Lunap99

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I am new to podiatry coding. Can someone tell me when it is appropriate to bill office visits 99xxx vs the G0245-47? If I use the G codes, would I use the 11055, 110721... codes. What documantation is needed to qualify the visit as an exam vs just the nails and or callus care. We recently picked up this podiatry client and I'm going to have to re-instruct the providers if they are billing these wrong.
 

Pam Brooks

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Overall, if Medicare has a HCPCS code for that service, don't use an E&M code. Also, if scheduled for foot care, don't also bill an E&M unless there's a change in care plan, or a new problem. The RAC, OIG and the MACs are all over this kind of service, because it's so complicated and so often billed (and paid) inappropriately.
 

Lunap99

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Overall, if Medicare has a HCPCS code for that service, don't use an E&M code. Also, if scheduled for foot care, don't also bill an E&M unless there's a change in care plan, or a new problem. The RAC, OIG and the MACs are all over this kind of service, because it's so complicated and so often billed (and paid) inappropriately.
I appreciate this information. I have read these articles but I am still unsure. We have people that come in frequently to get the nails and calluses done, usually every 10 weeks or so. I know the eval codes can only be used every 6 months. I haven't actually seen anything stating the frequency of the routine foot care. I have been seeing a lot of visits where they perform nail debridement and callus trimming then bill 99213. I feel like that is not corrrect but I don't know if I should just add 11721 an 11055 or remove the 99213 and just bill the other 2 or should I use the G0247?
 

podcoder70

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Hello! Podiatry coding is very detailed and MAC specific. If a new patient comes in to establish and have foot care, you can bill the e&m along with the treatment. If the patient comes in just for callus or nail treatment and it is not a new issue, an e&m is not appropriate unless the patient also has a complaint that is unrelated to the callus and nails and is being treated that visit. As a rule, Medicare does not cover "diabetic foot exams" as they do not cover "screening" visits.
Feel free to reach out to me toniasilva856@gmail.com I have 20+ years experience in podiatry.
 

podcoder70

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I appreciate this information. I have read these articles but I am still unsure. We have people that come in frequently to get the nails and calluses done, usually every 10 weeks or so. I know the eval codes can only be used every 6 months. I haven't actually seen anything stating the frequency of the routine foot care. I have been seeing a lot of visits where they perform nail debridement and callus trimming then bill 99213. I feel like that is not corrrect but I don't know if I should just add 11721 an 11055 or remove the 99213 and just bill the other 2 or should I use the G0247?
We call that "routine foot care" and no, an e&m should not be billed every time they come in for nails and calluses.
 

WHAUN

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Would a 99212 be appropriate if the patient hasn't been seen for foot care with our clinic since 7/28/2020? Pt had callus trim and nail debridement at that visit back in 2020 and is coming back now almost a year later for the same. Dr has chosen codes: 99212,11055,11721
 

podcoder70

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There is a lot of debate on that, sorry for the delayed response. It's all about documentation. What is the doctor "evaluating and treating"? An "annual exam" is not payable for podiatry. The patient needs to have a complaint that is being treated and needs to have a "work up". Perhaps there was a new callus from last visit, or increased numbness that is discussed, or new fungal nails. Again, documentation is the key to support the E&M. Feel free to reach out to me, Wendy.
 

lipstick

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there have to be certain ICD-10 codes to support 11055-11057 and 11720/21. Medicare will not pay for these services if they are performed more frequently than 9 weeks. The every 6 months is the Date Last Seen for certain systemic chronic conditions. It is complicated. To bill the e/m, it would need to be separate form the foot care services. There might be other reasons why the patient is being seen. I think there are some unanswered questions
 

napahny@aol.com

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Martinez
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Hello! Podiatry coding is very detailed and MAC specific. If a new patient comes in to establish and have foot care, you can bill the e&m along with the treatment. If the patient comes in just for callus or nail treatment and it is not a new issue, an e&m is not appropriate unless the patient also has a complaint that is unrelated to the callus and nails and is being treated that visit. As a rule, Medicare does not cover "diabetic foot exams" as they do not cover "screening" visits.
Feel free to reach out to me toniasilva856@gmail.com I have 20+ years experience in podiatry.
Hello dear, I would like to ask for your help in podiatry billing, may I email you few questions?
Thank you in advance!
Mariam
Napahny@aol.com
 
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