“I documented a women’s size 10.5 shoe measurement in my Medicare note and then ordered the shoes from my diabetic shoe supplier. The supplier mailed me a pair of men’s 8.5 shoes since they are essentially the same size as a woman’s 10.5. In an audit, would Medicare have a problem with the size discrepancy, since I have to document that I dispensed a men’s 8.5 rather than the originally fitted women’s 10.5?”
In order to obtain the appropriate size of extra depth, therapeutic shoes for the patient and bill HCPCS Level II code A5500 (FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND SUPPLY OF OFF-THE SHELF DEPTH-INLAY SHOE MANUFACTURE TO ACCOMMODATE MULTI-DENSITY INSERT(S), PER SHOE.), it needs to be documented within the medical record on the date of service that the patient orders the diabetic shoes that the “patient was measured by Brannock device for heel to toe measurement of both the left foot and the right foot.” This not only documents the fact that you, as the provider and the supplier of the diabetic shoes made sure that the correct shoe size will be ordered, but also to make sure that the correct size shoes will be obtained and dispensed and fit to the patient’s feet.
When you look at the Coding Guidelines for “Therapeutic Shoes for Diabetics” specifically within the article associated with the LCD, it clearly states:
CODING GUIDELINES
A depth shoe (A5500) is one that:
1. Has a full length, heel-to-toe filler that when removed provides a minimum of 3/16” of additional depth used to accommodate custom-molded or customized inserts;
and
2. Is made from leather or other suitable material of equal quality; and
3. Has some form of shoe closure; and
4. Is available in full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent. (The American last sizing schedule is the numerical shoe sizing system used for shoes in the United States.)
5. The shoe may or may not have an internally seamless toe.
Obviously when you read over number 4, it is evident that the actual size does matter. Therefore, if the patient was measured and the size was a women’s size 10.5, but the supplier shipped a pair of men’s size 8.5 since they are “essentially the same size” as the women’s 10.5, this needs to be rectified by one of two options:
1. Obtain a letter from the shoe supplier stating that a size women’s 10.5 is synonymous and the same as a size men’s 8.5.
2. Obtain the ordered shoe in a women’s size 10.5.
Remember that you are dealing with Medicare. My suggestion? I would go with option number 2.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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