1. Are podiatrists allowed to perform a fall risk exam only in specific cases (in patients over 65, ones with prior history of falling, etc.) or general wellness exam G0438?
2. Would diagnostic code V700 be used or is it too unspecific? In cases of limb pain, would using M79. 60 be appropriate?
3. It is my understanding that the fall risk exam can only be performed in the office once a year. Would I use G0438 for the first time and G0439 for subsequent assessments?
4. Can I use G0245 once per year for diabetic patients that are getting a diabetic foot exam? If so, I assume that G2045 must be used by itself without any other E/M code. Please confirm that this is correct.
5. If using a complete gait analysis system (computerized and with specialized equipment that involves recording the patient's gait, or stride, to determine symmetrical or atypical movement patterns) is it appropriate to bill for any of the following codes as part of postural analysis during movement and/or fall risk assessment?
92548,97750,97755,97760,97761,97763,95851.
Question #1: Podiatrists are certainly able to perform an annual fall risk assessment. The Centers for Disease Control and Prevention (CDC) and the American Geriatric Society recommend yearly fall assessment screening for all adults 65 years of age and older. If the screening shows you are at risk, you may need an assessment. A fall risk assessment should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance.
HCPCS Level II code G0438 is defined as the following: Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial service. This is an appropriate code to be billed by the patient's PCP. This is not a code for a DPM. Based upon the documentation in the medical record for the date of service in question when the annual fall risk assessment was performed, in all likelihood a 99213 would be the correct code to bill.
Question #2: V700 - ICD 9 Diagnosis Code - Routine general medical examination at a health care facility. ICD-10-CM code M79.60 is defined as the following: Pain in limb, unspecified. If this code set is to be used, it needs to be expanded to 6 characters: M79.604: Pain in right leg/Pain in right lower limb, NOS or M79.605: Pain in left leg/ Pain in left lower limb, NOS.
Question #3: A fall risk exam can be performed annually for all adults 65 years of age and older. If the screening shows you are at risk, you may need an assessment. A fall risk assessment should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance. HCPCS Level II codes G0438 and G0439 are the two codes in question. It is inappropriate for a DPM to bill these 2 HCPCS Level II codes. As I stated earlier, based upon the medical record documentation E/M code 99213 would in all likelihood be the most appropriate code to bill.
Question #4: HCPCS Level II code G0245 is not the appropriate code to bill for diabetic patients that are getting an annual diabetic foot exam. Once again, based upon the medical record documentation that was accrued from the diabetic foot exam, E/M code 99213 would in all likelihood be the most appropriate code to bill.
G0245 is very specific. It is defined as the following: Initial Physician Evaluation and Management of a diabetic patient with 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:
-Visual inspection of the forefoot, hindfoot, and toe web spaces
- Evaluation of protective sensation
- Evaluation of foot structure and biomechanics
- Evaluation of vascular status and skin integrity
- Evaluation and recommendation of footwear
4. Patient education
LOPS codes (G0245, G0246, G0247) will be denied if Routine Foot Care codes 11055, 11056, 11057, 11719, 11720, and/or 11721 were billed and paid within the past 6 months.
Question #5: It would not be appropriate to bill for any of the following codes as part of postural analysis during movement and/or fall risk assessment: 92548,97750,97755,97760,97761,97763,95851.These CPT codes are all specific tests and measurements that are not and should not be part of a fall risk assessment.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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