11/25/2019    Lawrence Rubin, DPM

Coding for a Diabetic Foot Check with No Abnormalities

I believe the many comments and responses made
on this subject amount to trying to answer this
question: Can you bill a new patient Evaluation
and Management (E/M) service for a preventive
foot examination of a diabetic patient referred
by a physician if there are no present diseases
or disorders of the lower extremities? In
addition, there would presumably not be medical
record documentation of the required E/M "Chief
Complaint" or "Nature of the Presenting
Problem."

On the issue, while a podiatric comprehensive
diabetes foot examination is universally
accepted to be an immensely valuable preventive
screening service, this does not mean that
insurers are willing to pay for it.
Unfortunately, Medicare, Medicaid, and to the
best of my knowledge, most commercial insurance
payers will consider a podiatric foot
examination of a diabetic new patient who does
not presently have a disease or disorder of the
lower extremities to be a non-covered,
preventive screening service.

Billing the service using an ICD diagnosis code
for diabetes that does not also identify a lower
extremity complication (such as diabetic
peripheral neuropathy) is not acceptable. The
claim will be denied because this implies a
podiatrist is treating the diabetes. The
treatment of diabetes is not included within the
insurance industry taxonomy of eligible services
provided by a podiatrist. Some claims billed
this way may pass through an occasional
insurer's payment system, but the end result may
be a future audit and demand for return of an
overpayment.

So, I imagine the answer to the question is,
yes. You can bill for a diabetic foot screening
on a patient who has no lower extremity disease
or symptoms of disease. But don't be surprised
if the patient's insurance does not cover it.

Lawrence Rubin, DPM, Las Vegas, NV

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