“I am curious when and how to bill G0127 or G0247 instead of CPT code 11721 when performing Routine Foot Care.”
CPT code 11721 is defined as: Debridement of nail(s) by any method(s); 6 or more. This CPT code is billed when “At Risk,” routine foot care (RFC) is performed and also when symptomatic mycotic toenails are debrided.
HCPCS Level II code G0127 is defined as: Trimming of dystrophic nails, any number. This code is billed when a patient is provided with “At Risk,” RFC and the nails that are addressed and trimmed are documented as dystrophic.
When HCPCS Level II code G0247 is discussed, this creates a whole new scenario. We are now speaking about diabetic peripheral neuropathy and the treatment of diabetics with loss of protective sensation (LOPS).
Peripheral neuropathy with LOPS, secondary to diabetes, is a localized illness of the feet. Foot exams for people with diabetic LOPS are reasonable and necessary to allow for early intervention in serious complications that typically afflict diabetics.
Medicare covers, as a physician service, an examination and treatment of the feet every six months for individuals with a documented diabetic LOPS, as long as the patient has not seen a foot care specialist for some other reason in the interim. The following HCPCS Codes are to be used:
G0245 Initial Physician Evaluation and Management of a diabetic patient with LOPS which must include:
1. The diagnosis of LOPS
2. patient history
3. 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
G0246 Follow-up Physician Evaluation and Management of a diabetic with LOPS to include at least the following:
1. patient history
2. physical examination that includes;
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
3. Patient education
G0247 RFC by a physician for a diabetic patient with diabetic sensory
neuropathy resulting in LOPS to include, if present, at least the following:
- Local care of superficial wounds
- Debridement of corns and calluses
- Trimming and debridement of nails
Code G0247 must be billed on the same date of service with either G0245 or G0246 in order to be considered for payment. None of the covered RFC modifiers is appropriate, required or needed. The use of a Q7, Q8, or Q9 modifier with these codes may result in non-payment. LOPS codes (G0245, G0246, G0247) will be denied if RFC codes CPT 11055, CPT 11056, CPT 11057, CPT 11719, CPT 11720, and/or CPT 11721 were billed and paid within the prior 6 months. Once a patient’s condition has progressed to the point where RFC becomes a covered service, payment will no longer be made for LOPS services. Those services are considered included within the RFC service. Physicians must then bill the RFC codes along with the appropriate modifier.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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