RE: Medicare Foot Care --> RE: 2 0r 3 things

[Guest guest]

Routine nail trimming is easy enough to do with a good heavy duty pair of OTC toenail clippers that look kind of like side cutters or wire cutters. I also use disposable emeryboard/nail files. While there is little to no reimbursement for routine nondiabetics. The elderly apriciate it and you can often prevent problems and find PVD early by examining a foot that might often get overlooked in a nondiabetic and it can be done easily while getting a history lesson or listening to a nice story. More involved podiatry can make you a few bucks with partial removal of ingrown nails (that does require a nail splitter and I use a periosteal elevator(dentist tool) it dosen't take very long and are kinda fun to do. Most patients really like not having to go to another doc to have it done. Melody I have a

patient that reminds me of the time he was "stood up by an owl" when I rescheduled him to take a young barred owl to the wildlife rehabilitation place last summer after it was hit near my home. Locke's in Colorado wrote: Good find, Sujay, but it looks like the restrictions are somewhat limiting. This article is a few years old, but probably hasn't changed. http://www.acfas.org/practicemang/medicare-medicaid/coverage.htm New Medicare Foot Care Coverage Effective July 1, 2002 The Centers for Medicare and Medicaid Services (CMS) recently announced that, effective July 1, 2002, Medicare will cover, as a physician service, an evaluation (examination and treatment) of the feet no more often than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation (LOPS), as long as the patient has not seen a foot care specialist in the interim. The applicable new HCPCS Codes required for reporting these services are as follows: HCPCS Code DescriptorGO245 Initial physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation

[This initial examination must include a diagnosis of LOPS, patient history, physical examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.] It is important to note that each provider or provider group of which a physician is a member, may only receive reimbursement once for G0245 for each beneficiary. However, should that beneficiary need to see a new provider, that new provider may also be reimbursed once for G0245 for that beneficiary. GO246 Follow-up evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) [This follow-up examination must include a diagnosis of LOPS, patient history, physical

examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.] GO247 Routine foot care of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) [if present, this care must include local care of superficial wounds, debridement of corns and calluses, and trimming and debridement of nails.] Code GO247 Must be billed on the same date of service with either GO245 or GO246 in order to be considered for payment. FEE & RVU Information 2003 Medicare National RBRVS Physician Fees CPT/HCPCS Code Non-Facility Physician In-Facility Physician Fee G0245 $62.54 $45.98 G0246 $36.42 $23.17 G0247 $39.36 $27.96 CPT/HCPCS Code Non-Facility Total RVU In-Facility Total RVU G0245 1.7 1.25 G0246 0.99 0.63 G0247 1.07 0.76 Diagnosis CodesThe above G0245-G0247 codes should be reported with one of the following diagnosis codes in conjunction with this benefit: 250.60 Diabetes with Neurological Manifestations, Type II, [Non-Insulin Dependent Type] [Adult-Onset Type] or Unspecified Type, Not Stated as Uncontrolled Fifth-digit "0" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin. 250.61 Diabetes with Neurological Manifestations, Type I [insulin Dependent Type] [iDDM Type] [Juvenile Type], Not Stated as

Uncontrolled 250.62 Diabetes with Neurological Manifestations, Type II [Non-Insulin Dependent Type] [NIDDM Type] [Adult-Onset Type] or Unspecified Type, Uncontrolled Fifth-digit "2" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin. 250.63 Diabetes with Neurological Manifestations, Type I [insulin Dependent Type] [iDDM] [Juvenile Type], Uncontrolled 357.2 Polyneuropathy in Diabetes[Code first underlying disease (250.6x)] From:

[mailto: ] On Behalf Of Shlifer StaffSent: Tuesday, May 06, 2008 10:26 AMTo: Subject: RE: 2 0r 3 things Check this out: •G0247 –Routine foot care –Care of superficial wounds –Debridement of corns and calluses –Trimming and debridement of nails •Billed same date of service as G0245 or G0246LOPS HCPCS Codes 3LOPS 3 from

https://www.noridianmedicare.com/p-medb/train/presentations/diabetic_benefits.pdf. I haven't used it yet, as I just ran across it this morning. I had no idea Medicare had so much information available online. SujayJim.KennedyUCHSC (DOT) edu wrote: Yes, but medicare does not pay for this or corns or callouses.________________________________From: on behalf of Sent: Tue 5/6/2008 8:38 AMTo: Subject: 2 0r 3 thingsHi Happy tuesday -Does anybody cut toenails?I never get around to this but I have so many people who cannot each or see their feet , no reason not, to yes ?I suppose you cannot believe I am on a national cutting edge(get it) list s erv asking for toenail cutting advice(Doesn; t jean know ho to do that??) I suppose just buy some god tool and increase the level of the visit?- 5 Barred owls last night outside -at least 5 we heard!!- ANYONE going to CAMP have any left over from conferecnes plastic name tags?I have been giveing people their med lists in them but ran out of my supply. People like this . Sometims I do a whole cover sheet thing with their Dt, allergies ,and meds as well .if you have some could you bring them to camp, or even mail them if you feel that generous,

thanks? If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

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[Guest guest]

This whole topic brings up the issue (again) of why we throw up our hands and say "well, it's not covered, so it's a money loser".

Technically, if it's not covered by Medicare, it's still a billable treatment, yes?

Sort of like cosmetics, acupuncture, etc - not covered by Medicare, but you can still treat the patient and bill them.

Why shouldn't we slap a value on the treatment of nail cutting ($10, $20, $1,000 or whatever) and let the patient know that this is an uncovered therapy that we feel is very important and if they would like to receive the therapy, here is the price.

Heck, my understanding is...if it's not even covered by Medicare, you don't even need to get an ABN.

Of course, I probably won't be doing this procedure any time soon -- but we should not undervalue ourselves and just give away great care just because Medicare says they won't pay for it.

Just a thought.

Locke, MD

From: [mailto: ] On Behalf Of Melody PrattSent: Tuesday, May 06, 2008 2:45 PMTo: Subject: Re: Medicare Foot Care --> RE: 2 0r 3 things

Routine nail trimming is easy enough to do with a good heavy duty pair of OTC toenail clippers that look kind of like side cutters or wire cutters. I also use disposable emeryboard/nail files. While there is little to no reimbursement for routine nondiabetics. The elderly apriciate it and you can often prevent problems and find PVD early by examining a foot that might often get overlooked in a nondiabetic and it can be done easily while getting a history lesson or listening to a nice story.

More involved podiatry can make you a few bucks with partial removal of ingrown nails (that does require a nail splitter and I use a periosteal elevator(dentist tool) it dosen't take very long and are kinda fun to do. Most patients really like not having to go to another doc to have it done.

Melody

I have a patient that reminds me of the time he was "stood up by an owl" when I rescheduled him to take a young barred owl to the wildlife rehabilitation place last summer after it was hit near my home.

Locke's in Colorado wrote:

Good find, Sujay, but it looks like the restrictions are somewhat limiting.

This article is a few years old, but probably hasn't changed.

http://www.acfas.org/practicemang/medicare-medicaid/coverage.htm

New Medicare Foot Care Coverage Effective July 1, 2002

The Centers for Medicare and Medicaid Services (CMS) recently announced that, effective July 1, 2002, Medicare will cover, as a physician service, an evaluation (examination and treatment) of the feet no more often than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation (LOPS), as long as the patient has not seen a foot care specialist in the interim.

The applicable new HCPCS Codes required for reporting these services are as follows:

HCPCS Code DescriptorGO245 Initial physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation

[This initial examination must include a diagnosis of LOPS, patient history, physical examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.]

It is important to note that each provider or provider group of which a physician is a member, may only receive reimbursement once for G0245 for each beneficiary. However, should that beneficiary need to see a new provider, that new provider may also be reimbursed once for G0245 for that beneficiary.

GO246 Follow-up evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

[This follow-up examination must include a diagnosis of LOPS, patient history, physical examination that includes an inspection of the forefoot, hindfoot, and toe web spaces; evaluation of: protective sensation, foot structure and biomechanics, vascular status and skin integrity, evaluation and recommendation of footwear, and providing of patient education.]

GO247 Routine foot care of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS)

[if present, this care must include local care of superficial wounds, debridement of corns and calluses, and trimming and debridement of nails.]

Code GO247 Must be billed on the same date of service with either GO245 or GO246 in order to be considered for payment.

FEE & RVU Information

2003 Medicare National RBRVS Physician Fees

CPT/HCPCS Code

Non-Facility Physician

In-Facility Physician Fee

G0245

$62.54

$45.98

G0246

$36.42

$23.17

G0247

$39.36

$27.96

CPT/HCPCS Code

Non-Facility Total RVU

In-Facility Total RVU

G0245

1.7

1.25

G0246

0.99

0.63

G0247

1.07

0.76

Diagnosis CodesThe above G0245-G0247 codes should be reported with one of the following diagnosis codes in conjunction with this benefit:

250.60

Diabetes with Neurological Manifestations, Type II, [Non-Insulin Dependent Type] [Adult-Onset Type] or Unspecified Type, Not Stated as Uncontrolled

Fifth-digit "0" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin.

250.61

Diabetes with Neurological Manifestations, Type I [insulin Dependent Type] [iDDM Type] [Juvenile Type], Not Stated as Uncontrolled

250.62

Diabetes with Neurological Manifestations, Type II [Non-Insulin Dependent Type] [NIDDM Type] [Adult-Onset Type] or Unspecified Type, Uncontrolled Fifth-digit "2" is for use for type II, adult-onset diabetic patients, even if the patient requires insulin.

250.63

Diabetes with Neurological Manifestations, Type I [insulin Dependent Type] [iDDM] [Juvenile Type], Uncontrolled

357.2

Polyneuropathy in Diabetes[Code first underlying disease (250.6x)]

From: [mailto: ] On Behalf Of Shlifer StaffSent: Tuesday, May 06, 2008 10:26 AMTo: Subject: RE: 2 0r 3 things

Check this out:

•G0247 –Routine foot care

–Care of superficial wounds

–Debridement of corns and calluses

–Trimming and debridement of nails

•Billed same date of service as G0245 or G0246LOPS HCPCS Codes 3LOPS 3

from https://www.noridianmedicare.com/p-medb/train/presentations/diabetic_benefits.pdf. I haven't used it yet, as I just ran across it this morning. I had no idea Medicare had so much information available online. SujayJim.KennedyUCHSC (DOT) edu wrote:

Yes, but medicare does not pay for this or corns or callouses.________________________________From: on behalf of Sent: Tue 5/6/2008 8:38 AMTo: Subject: 2 0r 3 thingsHi Happy tuesday -Does anybody cut toenails?I never get around to this but I have so many people who cannot each or see their feet , no reason not, to yes ?I suppose you cannot believe I am on a national cutting edge(get it) list s erv asking for toenail cutting advice(Doesn; t jean know ho to do that??) I suppose just buy some god tool and increase the level of the visit?- 5 Barred owls last night outside -at least 5 we heard!!- ANYONE going to CAMP have any left over from conferecnes plastic name tags?I have been giveing people their med lists in them but ran out of my supply. People like this . Sometims I do a whole cover sheet thing with their Dt, allergies ,and meds as well .if you have some could you bring them to camp, or even mail them if you feel that generous, thanks? If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD ph fax

Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.

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