06/07/2013    Ed Davis, DPM

Diabetic Shoes for Medicare Patients

The changes in Medicare documentation
requirements for diabetic shoes has made the
provision of this service challenging. APMA held
a webinar on this topic in January and mentioned
that it was working on a satisfactory resolution
to ensure coverage/compliance. I have not heard
anything further from APMA since then.

The most difficult requirement is obtaining
information within the body of the PCP progress
notes documenting the need for diabetic shoes.
It is unclear as to what those notes must
specifically state or document. We have obtained
a separate certification statement documenting
the following for a number of years:

The need for therapeutic shoes must be certified
by a physician who is an M.D. or D.O. and who has
the primary responsibility for treating the
patient’s systemic diabetes. This physician must:

1. Document in the patient’s medical record that
the patient has diabetes; and
2. Certify that the patient is being treated
under a comprehensive plan of care for diabetes,
and that the patient needs diabetic shoes; and
3. Document in the patient’s medical record the
presence of one or more of the following
conditions:
a. Previous amputation of the other foot, or part
of either foot, or
b. History of previous foot ulceration of either
foot, or
c. History of pre-ulcerative calluses of either
foot, or
d. Peripheral neuropathy and evidence of callus
formation of either foot, or
e. Foot deformity of either foot, or
f. Poor circulation (i.e., small or large vessel
arterial insufficiency) in either foot.

A new certification statement, signed and dated
by the treating physician, must be provided on a
yearly basis in order to obtain a new pair of
shoes or inserts.

This information still be required but the
process of obtaining separate information from
the PCP progress notes is an issue because:
1) It is uncertain exactly what the PCP need
document.
2) It is uncertain what time frame that such
documentation need be done.
3) The logistics of obtaining such notes is at
issue since it may involve having the PCP spend
time going through notes.
4) The primary care doctor or doctor managing the
diabetes often does not perform a foot exam but
defers that to the podiatrist.

Does anyone have information as to what actions
the APMA currently recommends on this issue?
Are readers here still supplying diabetic shoes
and, if so, are there difficulties with coverage?

Ed Davis, DPM, San Antonio, TX,
ed@sanantoniodoc.net

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