Stephnaie Posted Mon 18th of November, 2013 13:49:24 PM
My podiatrist sees a lot of patients with DM. Would it be appropriate to code the 2028F along with G0245 for their initial visit. Can you specify what 2028F involves please.
SuperCoder Answered Mon 18th of November, 2013 17:23:48 PM
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 (99201–99215) 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 diabetic sensory neuropathy resulting in a LOPS) has been billed for that patient in the previous 6 months. Bill ICD-9 diagnosis code 250.XX plus an additional diagnosis code for the specific manifestations, per CMS .
SuperCoder Answered Mon 18th of November, 2013 17:24:55 PM
I am still working to get you the complete answer.