G0245 and G0246 Evaluation and management of diabetic patient with diabetic LOPS

PennyG

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Can these codes be billed in the physician office? I am finding an old Medicare policy that states they are to be billed in the hospital, critical access hospital, rural health clinic, etc.
 

PennyG

Networker
Messages
78
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G0245 and G0246

Does anyone have any insight on whether these codes can be billed in a Physician's Office? The medical policy that I am seeing from 2005 does not have physician's office listed. Hoping for some assistance with this.
 
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Hi,

Please find the below coding information I received:

Some of the services that Medicare will cover for diabetics diagnosed with sensory neuropathy and LOPS include cutting or removal of corns and calluses; nail trimming, cutting, or debriding; and preventive maintenance foot care. These can be performed in the office, in an outpatient setting, or in the patient’s home.

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
Short Description: INITIAL FOOT EXAM PT LOPS

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
Short Description: ROUTINE FOOTCARE PT W LOPS

Regards,
Lavanya Mohan
 
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Hi,

I have one more point to add:

CMS’s National Correct Coding Initiative (CCI) edits consider G0245 to be a part of an E/M code. For this reason, you can’t claim reimbursement for both G0245 and an office or outpatient E/M code (99201-99215) for the same date of service, as they are bundled together. Since you have to choose one or the other, you might be best off with billing the G0245 and skip the E/M code for that visit, depending on what the E/M code involves, of course.

Regards,
Lavanya Mohan
 
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