Podiatry Coding Clinic: G0245 and G0246

Here’s when you may need to get an ABN Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS) have been in force since 2002. Yet many still find the related G codes confusing. Today, let’s nail down the what documentation should be in the podiatrist’s note [...] Related articles:

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Here’s when you may need to get an ABN

Medicare policies covering routine foot care for diabetic patients suffering from peripheral neuropathy with loss of protective sensation (LOPS) have been in force since 2002. Yet many still find the related G codes confusing. Today, let’s nail down the what documentation should be in the podiatrist’s note when you use G0245 or G0246.

First, let’s review CMS’s descriptors for these two codes:

• G0245 (Initial physician Evaluation and Management (E/M) of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) …) — You’ll use this code when a patient sees your podiatrist for the first time. This G code represents routine foot care for patients who have adequate circulation and diabetes, but who also have a documented loss of sensation.

• G0246 (Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) …) — You will use this code for a diabetic patient’s follow-up visit with your podiatrist.

Look for these 6 things in documentation for G0245 or G0246

If your payer decides to audit your diabetic neuropathy routine foot care claims, you may end up having to pay back a portion of your reimbursement if the podiatrist’s documentation doesn’t meet certain documentation requirements.

Make sure that the medical record contains the patient’s medical history that indicates he has diabetic neuropathy. Your podiatrist’s documentation of the physical examination should include all of the following:

• Visual inspection of forefoot and hind foot (including toe web spaces)

• Evaluation of protective sensation

• Evaluation of foot structure and biomechanics

• Evaluation of vascular status and skin integrity

• Evaluation of the need for special footwear

• Patient education.

Don’t overlook: Be sure your practice documents in the patient’s chart which MD or DO certified the “systemic condition.” Your podiatrist should also be sure to document the date of the patient’s most recent visit with a physician for foot care within the last six months, according to Paul Fehring, owner of Drs. Central Billing, a podiatry-only billing company based in Fairfield, Ohio.

Here’s why: Medicare coverage entitles individuals with a documented diagnosis of diabetic sensory neuropathy and LOPS to an evaluation and treatment of the feet once every six months for as long as the patient has not seen a foot care specialist in the interim, according to the routine foot care LCD from Trailblazer.

Codes G0245-G0247 refer to any foot care by any type of physician, not only podiatrists. Make sure that your podiatrist asks the patient if he has received any type of foot care in the past six months. If the patient isn’t sure, have him sign an advance beneficiary notice (ABN) before providing care.

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