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Medicare Diabetic Foot Exam Form

Coding & Documentation -- Fpm

Coding & Documentation -- Fpm

Can doctors legally charge for a no-show appointment, and what should the rate be based on? In some cases, charging for no-show appointments may be permissible. Federal Medicaid policy does not permit providers to bill Medicaid or beneficiaries any fee for missing a scheduled appointment. This may be true of some managed care contracts as well. On the other hand, the Centers for Medicare & Medicaid Services allows physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they also charge non-Medicare patients for missed appointments. State law may have bearing on this answer so check with your attorney or state medical board. A rule of thumb for setting the fee would be to cover the costs of pre-appointment work (e.g., establishing or reviewing a chart) or any actual lost business opportunity (e.g., an unfilled appointment slot). Be sure to also consider how you will provide notification of the new fee policy to every patient and what customer service training may be necessary to avoid conflict between staff and patients when the fee is charged. When a Medicare patient with diabetes needs a foot exam and an order for shoes, what codes should I report? Are there separate codes and modifiers to report in addition to the evaluation and management (E/M) visit code? Medicare does not allow for separate payment of an E/M code and a diabetic foot evaluation on the same date. Should you provide a diabetic foot exam to a patient with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation and not provide significant other E/M services on the same date, it may be beneficial to report this using the codes for the diabetic foot evaluation and treatment. It is important to understand the Medicare benefit and its Continue reading >>

Follow The Guidelines For Diabetic Foot Care Coding

Follow The Guidelines For Diabetic Foot Care Coding

With the susceptibility diabetics have for losing feeling in their feet — a condition called loss of protective sensation, or LOPS — good foot care is vital for people with diabetes. When people develop diabetic sensory neuropathy and LOPS, they may be unable to feel when a stone gets lodged in their shoe, or if they step on glass, or burn their feet on hot pavement. With the poor wound healing that is inherent to diabetes, situations like this can quickly turn disastrous. For this reason, Medicare and many other payers cover special diabetic foot examination and treatment every six months for people who have documented diabetic sensory neuropathy and LOPS. Here are some tips for success with reporting diabetic foot care. Choose the Correct Procedure Codes 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. You can choose from among several HCPCS G codes to report these services. G0245, Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) … Report G0245 the first time a diabetic patient sees your provider. You’ll use this code to report routine foot care for patients who have diabetes and a documented loss of sensation but who have adequate circulation. G0246, Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)… When an established diabetic patient comes in for follow-up care, you may report G0246. G024 Continue reading >>

The Low Down On Diabetic Shoes

The Low Down On Diabetic Shoes

Diabetic therapeutic shoes are, in my opinion, one of the most important parts of my job. Diabetic shoes help save feet, plain and simple. According to the American Diabetes Association, each year 600,000 diabetic patients get foot ulcers, resulting in over 80,000 amputations. As a podiatric physician I try to embrace preventative care modalities such as regular diabetic foot exams and diabetic shoes to prevent my patients from getting foot ulcers. My patients will tell you that I’m a stickler about these things. I do understand patient concerns over cost, but the vast majority of insurances cover diabetic shoes and insoles. It is widely accepted that preventative medicine is the best medicine, and not only the monetary cost but also the emotional and physical cost of an amputation makes money spent on diabetic shoes and insoles money well spent. So, what makes diabetic shoes and insoles so different from your run-of-the-mill shoe? Which patients need them? And how do you know if insurance will cover them? Read on for the low down on diabetic shoes. The Definition: Diabetic shoes can also be referred to as extra depth or therapeutic shoes. They are specially designed shoes intended to reduce the risk of skin breakdown in diabetics with co-existing foot problems (such as neuropathy, poor circulation, and foot deformities). Why They’re So Special: Diabetic shoes are extra deep to accommodate diabetic insoles or orthotics. They have a built in firm heel counter to provide medial and lateral rearfoot stability. The toe box of the shoe is higher so there is plenty of room for toes (even ones that like to stick up like hammertoes). There is little to no stitching on the inside of a diabetic shoe. The stitching is on the outside. Sometimes even the smallest prominence can Continue reading >>

Medicare Coverage Of Foot Care

Medicare Coverage Of Foot Care

Care by a physician, podiatrist, or other Medicare-approved healthcare provider for injury, disease, or other medical conditions affecting the foot, ankle, or lower leg Medicare Part B covers medically necessary care for treatment of injury, disease, or other medical conditions affecting the foot, ankle, or lower leg. It covers this treatment if provided by a physician (M.D.) or a Medicare-certified podiatrist (doctor of podiatric medicine, or DPM). This can include treatment for chronic conditions, such as bunion deformities and heel or toe spurs. Medicare Part B doesn't cover routine foot care that's not medically necessary. Foot examinations for people with diabetes and therapeutic shoes and inserts for people with diabetes-related foot conditions are covered differently by Medicare Part B. If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans , also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for foot care, contact the plan directly. Medicare Part B pays 80 percent of the Medicare-approved amount for covered foot care. Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements: The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that M Continue reading >>

Physician Information On Medicare Benefit For Therapeutic Footwear For Diabetics - Pedorthic Footcare Association

Physician Information On Medicare Benefit For Therapeutic Footwear For Diabetics - Pedorthic Footcare Association

Physician Information on Medicare Benefit for Therapeutic Footwear for Diabetics Physician Information on Medicare Benefit for Therapeutic Footwear for Diabetics Physicians have a unique and unparalleled opportunity to help qualified diabetic patients protect their feet, simply by filling out one short form that takes less than two minutes to complete. In 1993, Congress amended the Medicare statutes to provide partial reimbursement for depth shoes, custom-molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes. The law recognizes that footwear can help prevent lower-limb amputations in long-term diabetic patients. The Centers for Disease Control has estimated that 82,000 lower-limb amputations due to diabetes occur annually (2003 figures). Experts agree that most would have been preventable with an appropriate foot care program including footwear that is properly fit to the patient. The physician (M.D. or D.O.) who is managing the patient's systemic diabetic condition must certify that: 1. The patient has diabetes mellitus (ICD-9 diagnosis codes 249.00-250.93) 2. The patient has one or more of the following conditions. Physician must indicate which condition(s), for which the physician maintains documentation in his/her patient record. a. previous amputation of the other foot, or part of either foot, or b. history of previous foot ulceration of either foot, or c. history of pre-ulcerative calluses of either foot, or d. peripheral neuropathy with evidence of callus formation of either foot, or 3. That he/she is treating the patient under a comprehensive plan of care for diabetes; and Within a given calendar year, the qualifying patient can receive 80% of the allowed amounts for: * One pair of depth shoes and three pair of ins Continue reading >>

Routine Foot Care General Information

Routine Foot Care General Information

Routine foot care is not a covered Medicare benefit. Medicare assumes that the patient or caregiver will perform these services by themselves, and therefore, these services are excluded from coverage, with certain exceptions. The Centers for Medicare & Medicaid Services (CMS) has established national-level guidelines governing routine foot care and treatment of mycotic nails. The cutting or removal of corns or calluses. The trimming, cutting, clipping or debriding of nails. Hygienic and preventive maintenance care such as: The use of skin creams to maintain skin tone of either ambulatory or bedfast patients. Any other service performed in the absence of localized illness, injury or symptoms involving the foot. Medicare allows exceptions to this exclusion when medical conditions exist that place the beneficiary at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care if it is a necessary and integral part of otherwise covered services In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds or infections. The presence of a systemic condition such as metabolic, neurologic or peripheral vascular disease may result in severe circulatory embarrassment or areas of diminished sensation in the individuals legs or feet. In these instances, certain foot care procedures that otherwise are considered routine (as defined previously) may pose a hazard when performed by a nonprofessional person. The most common diagnoses that can represent the underlying conditions to justify coverage as exceptions to routine foot care exclusions are: Peripheral Continue reading >>

Medical Billing And Coding Forum

Medical Billing And Coding Forum

I work in internal medicine and we have a very high diabetic population on Medicare/MA plans. We are on Noridian Medicare. We have been trying to use the diabetic foot codes (G0245, G0246, G0247) They seem to be getting paid only intermittently and very rarely from Medicare. I can't figure out what I am doing wrong. On the other hand is anyone having any success using the corn removal codes getting paid by Medicare/ MA plans? Have you been following the CMS guidelines for G0245, G0246, G0247. According to the Claims Processing Manual 100-04, Chapter 32, Section 80 these code are paid every 6 months and only if the beneficiary has not seen a foot care specialist for some other reason in the interim. Also, once the condition has progressed to a point where routine foot care is a covered benefit these codes are no longer payable. Corn removal is a non-covered service except for patients with systemic disease who meet certain criteria. I had not been following those codes. New to internal medicine and trying to figure all this out! Thank you for the reference on the diabetic foot codes. Where can I find the info on the corn removal? Our patient's who are having foot care done by our doctor their feet are quite bad and they have not had this done within 6months elsewhere. Still, we are getting various denials. Not sure if Noridian has an LCD for Routine Foot Care, but here's the link to NGS' LCD (L26426) which will give you the information that CMS is looking for. Continue reading >>

Does Your Patient Need Diabetic Therapeutic Footwear? (where Benefit, Evidence, And Bureaucracy Collide)

Does Your Patient Need Diabetic Therapeutic Footwear? (where Benefit, Evidence, And Bureaucracy Collide)

In 2012, the estimated incremental burden of diabetic foot ulceration in all Medicare and non-Medicare patients in the United States was $9.1–13 billion (1). These costs do not include the suffering of patients and families, loss of income, loss of mobility, and predicted increased mortality. Coverage for extra-depth or custom-molded therapeutic shoes and inserts for individuals with diabetes became a Medicare benefit on 1 May 1993. Within 5 years of the benefit’s availability, a report from the Office of the Inspector General of the United States found that 57% of paid claims for therapeutic shoes had missing or inadequate documentation. An audit of beneficiaries found that 3% did not report having diabetes, 12% did not report any of the qualifying conditions, and 47% denied having a foot deformity or previous amputation (2). As with any government program, instances of fraud and abuse have been reported. Dr. Comfort shoes paid a fine of $27 million for providing inserts that did not meet Medicare standards (3). A provider in California was accused of entering an extended-care facility and offering free shoes to residents, telling them the government wanted them to have shoes. Individuals who did not walk were told the shoes would help them walk (4). To qualify for footwear coverage, Medicare beneficiaries must have diabetes plus one of the following conditions: neuropathy with evidence of callus, previous or current ulcer, previous or current pre-ulcerative callus, previous amputation, foot deformities, or poor circulation. How Medicare defines neuropathy (e.g., does it require an insensitive limb?), pre-ulcerative callus, foot deformity, or poor circulation is unclear. The Centers for Medicare & Medicaid Services requires that the treating physician (MD or DO) mu Continue reading >>

How To Obtain Reimbursement For Diabetic Foot Exams; When To File An Advance Beneficiary Notice Of Noncoverage

How To Obtain Reimbursement For Diabetic Foot Exams; When To File An Advance Beneficiary Notice Of Noncoverage

How to obtain reimbursement for diabetic foot exams; when to file an advance beneficiary notice of noncoverage Q: How can we be reimbursed for a diabetic foot exam (G0245) performed on the same day as an office visit? A: The CPT guidelines describe G0245 as "Initial physician evaluation and management [E/M] 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." The Centers for Medicare and Medicaid Services (CMS) considers G0245 to be an E/M code, and the Correct Coding Initiatives edits consider G0245 to be a component of E/M, which means that reimbursement for G0245 is included in the office visit code (9920199215) reimbursement when both the exam and the visit are billed on the same date of service. Therefore, these codes cannot be billed together. Also, these 2 services should not be billed on the same date of service because the diagnosis of diabetic sensory neuropathy resulting in a LOPS should be established and documented prior to coverage of foot care. LOPS should be diagnosed through sensory testing with the 5.07 monofilament. Once the diagnosis is established, however, CMS will pay a physician or group practice once for G0245. If the patient must see a new physician, however, the new physician may bill for G0245 if neither G0245 nor G0246 (follow-up physician E/M of a patient with dia Continue reading >>

Community Pharmacy: Diabetic Services

Community Pharmacy: Diabetic Services

Welcome to Community Pharmacy and our Diabetic Shoe Program! We are excited to serve you in protecting your feet from breakdown and/or ulceration by using properly fitted diabetic footwear. Our Certified Pedorthist is here to assist you in this important process. Please be aware that you must have Medicare Part B and meet the qualifying conditions for diabetic shoes (see Guide to Clinical Notes to understand what qualifies and must be noted in your chart when you see your Doctor for foot exam). Be aware that we are not contracted with Medicare Advantage Plans. Please follow the instructions below so that we can expedite the process of getting you into your new shoes. Print the Detailed Written Order to take to your Medical Doctor (MD or DO) to complete. The prescription must be specific as to the exact type and number of inserts your doctor decides you need. Print the Statement of Certifying Physician AND the Guide to Clinical Notes to take to your Medical Doctor (MD) or Doctor of Osteopathy (DO) who is treating you for your diabetes (cannot be NP or Podiatrist) and have them fill out these forms completely as well as provide notes from your chart specifically addressing the qualifying condition of your feet and the need for shoes. Once we receive all the completed paperwork, our office will call you to schedule an appointment. Please make sure that you bring your Medicare card (red, white and blue), drivers license or picture ID and finally, your supplemental insurance card to your scheduled appointment. Our Pedorthist will evaluate you and your needs and order the appropriate footwear required for you. You should receive your shoes and inserts within 1-2 weeks of your evaluation. Upon delivery of your therapeutic footwear, we will be glad to bill your insurance for y Continue reading >>

Therapeutic Shoes Questions And Answers

Therapeutic Shoes Questions And Answers

The following Therapeutic Shoes related questions and answers (Q&As) are cumulative from the web-based training(s) conducted. Some questions have been edited for clarity and answers may have been expanded to provide further details. Similar questions were combined to eliminate redundancies. Updated November 2017. Q1. How is criterion 2 of the Local Coverage Determination (LCD) met? A1. In order to meet criterion 2, the certifying physician must either: Personally document one or more of criteria 2a2f in the medical record of an in-person visit within six months prior to delivery of the shoes/inserts and prior to or on the same day as signing the certification statement; or Obtain, initial, date (prior to signing the certification statement), and indicate agreement (I agree) with information from the medical records of an in-person visit with a podiatrist, other M.D or D.O., physician assistant, nurse practitioner, or clinical nurse specialist that is within six months prior to delivery of the shoes/inserts, and that documents one of more of criteria 2a2f. It is not specific as to where the agreement exists but must be included on the medical record. A2. Foot deformity examples include bunions and hammertoes but are not limited to these. Q3. Will shoes be covered for neuropathy without any mention of callus or does it have to be with callus? A3. LCD criteria 2d specifically states, "Peripheral neuropathy with evidence of callus formation of either foot", so the medical record must have mention of neuropathy with evidence of callus formation of the foot to meet this criterion. Q4. What specific information must be included in the "fitting" chart note? A4. At the time of in-person delivery to the beneficiary of the items selected, the supplier must conduct an objective as Continue reading >>

How To Complete Diabetic Shoe Medicare Forms Correctly

How To Complete Diabetic Shoe Medicare Forms Correctly

Issue Number: Volume 29 - Issue 11 - November 2016 This author guides podiatrists through compliance paperwork for diabetic shoes that can help ensure payment for diabetic shoes. The purpose of this article is to provide the recipe to create a documentation packet that will pass a Diabetic Shoe Pre-Payment Review. If you have ever seen Chopped on the Food Network, chefs compete for $10,000 as they try to make stellar dishes using surprise ingredients. Thankfully, the Diabetic Shoe Compliance paperwork is nothing like Chopped. The required documents are clearly defined beforehand without any surprise ingredients. Read the ingredients and follow the directions. Since the “freshness” of the ingredients is important, the lifespan of each document is included. Although there are nine ingredients, the recipe is simple. 1. Detailed written order (prescription). Include space for prescribing shoes (A5500), the quantity of custom inserts (A5513) or quantity of prefab heat-moldable inserts (A5512). This must be dated within six months of dispensing shoes. 2. Statement of certification. Include space for asking the date of the last diabetic exam. The Statement of Certification must be dated within three months of dispensing shoes. (For the last diabetic exam, see item 3 below.) 3. Diabetes management exam. This is the diabetic exam progress note from the MD managing the patient’s diabetes. I recommend asking the MD only for the date of this exam. If the progress note is needed later for a pre-payment review, one can easily obtain the exam note. In my opinion, your referring MDs may object to copying their notes for every patient with diabetes. Giving you the date of the exam is much less time-consuming for the MD’s office. This must be an exam within six months of dispensi Continue reading >>

Mips Measures Relevant To Podiatry

Mips Measures Relevant To Podiatry

Quality - 50% of total score:Select 6measures including one Outcome measure (or high priority measure if an outcome measure is not applicable)and report each on 60% of eligible Medicare and non-Medicarepatient/visits for the entire year. Suggestions for your specialty include but are not limited to the following: #236 Controlling High Blood Pressure - High Priority *These 6 measures represent the Podiatry Specialty Measures Set PI:Promoting Interoperability (formerly ACI) -25% of total score:Replaces the Medicare EHR Incentive Program also known as Meaningful Use. A minimum of the following base measures are required if reporting this category. Note that EHR's certified to a 2014 edition report a different set of measures. IA:Improvement Activities - 15% of total score:Attest that you completed up to 2 high-weighted activities or 4 medium-weighted activities for a minimum of 90 days. Groups with 15 or fewer participants or if you are in a rural or health professional shortage area,attest that you completed1 high-weighted or 2 medium-weighted activities for a minimum of 90 days. There are over 90 possible measures to choose from. The following are suggestions only: Continue reading >>

Diabetes - Taking Care Of Diabetes With Lifestyle Management

Diabetes - Taking Care Of Diabetes With Lifestyle Management

Healthy eating is essential to managing diabetes. Your first step is to understand food. There are four basic food groups in a diet for managing diabetes: Carbohydrates, non-starchy vegetables, protein, and fat. Carbohydrates are turned into blood sugar (glucose) and used as energy or stored as fat in the body. To manage diabetes, pay attention to the total amount of carbohydrates. Non-starchy vegetables have a lesser effect on blood sugar than starchy ones; they provide valuable vitamins, minerals, and fiber. Protein helps your body maintain and grow muscle as well as provides some energy. Fats are an important part of a healthy diet and should not be eliminated. Vital for maintaining healthy skin and transporting fat-soluble vitamins, they have little effect on blood sugar. In addition to maintaining a diet of healthy foods, drinking plenty of water is extremely important to healthy living. You will want to drink about half your body weight in ounces of water per day. Exercising is a vital part of living well with diabetes. Exercising regularly is associated with: Reducing risk of heart disease or stroke, over time. Weight control is another important part of a healthy life with diabetes. Making a plan for healthy, gradual weight loss (about one or two pounds per week) can help you live better. Ask your doctor to help you set some goals and get started. Stress can elevate blood sugar levels, so controlling stress can help you manage diabetes. Living with diabetes can be its own source of stress, on top of other everyday stress. When a person with diabetes accepts and understands the diagnosis, then that person is ready to move forward. This opens up the path to feeling better by making diet and lifestyle changes, getting regular tests, and sticking with medicines. Ea Continue reading >>

Is My Test, Item, Or Service Covered?

Is My Test, Item, Or Service Covered?

How often is it covered? Medicare Part B (Medical Insurance) covers a foot exam every 6 months as long as you haven't seen a foot care professional for another reason between visits. Who's eligible? All people with Part B who have diabetes, diabetic peripheral neuropathy, and loss of protective sensations are covered. Your costs in Original Medicare To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them. Continue reading >>

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