11/27/2019    Bryan C. Markinson, DPM

Coding for a Diabetic Foot Check With No Abnormalities (Lawrence Rubin, DPM)

Dr. Rubin on this subject states that if there
is no symptom or clinical diagnosis, payers
won’t pay or may not pay, or we may be demanded
to pay money back if we get paid. I reject this
simply because If true, than my original
statement that all of our proclamations of
benefit of a diabetic foot exam, or podiatry
involvement in overall diabetic management,
cannot be beneficial only during complications,
but also in risk stratification and patient
education alone, are for naught.

If I am wrong about this, than there is a gaping
chasm in the reality of practice and what we
espouse as a core important contribution of our
profession. Dr. Jacob’s response and
contribution, (with which I fully agree) to the
original query of whether or not we can bill
and get paid for a diabetic foot exam on a
patient with no clinical findings or symptoms,
still fails to answer the question.

Although Dr. Jacobs includes risk stratification
independently as a worthwhile goal of the exam
(which in my opinion is all that should be
needed to justify one), Dr. Jacob’s also
intimates that that if you do a detailed exam as
he suggests, you will find something, with the
justification that findings in diabetics are
“common.” I do not disagree. The issue of
“finding something” has been a ball and chain
on the profession since the beginning, starting
with the ridiculous and never changing
restrictions on routine foot care. I am urged to
participate in the Diabetic Shoe Program (which
I will never do) as a patient with well
controlled diabetes and a asymptomatic bunion
gets $350 worth of shoes and inserts; but
“experts” say my exam to determine that the
circulation and neurosensory status, and skin
and nails are normal may not get paid.

Some experts say you “should” get paid, but keep
it a Level 2 E/M! However in many instances,
diabetics who are newly diagnosed within weeks
(and whose only issue currently is
hyperglycemia) are sent to me for this
evaluation. It’s part of meaningful use, pay for
performance data, and whatever quality measures
they are calling it this week. Some tell me that
I do not understand the difference between
“getting paid,” and “medically appropriate” and
what’s “stated in the carrier LCD.”

What I do understand is that to date, I have
NEVER been denied payment for an exam that
listed diabetes as the only diagnosis in these
patients. To re-iterate, Dr. Jacob’s post in
reality does support that there are typically
podiatric findings considered banal, but in the
face of persistent hyperglycemia are not so
banal and must be addressed. So the small
percentage of “no findings,” and/or “no
podiatric symptoms” in diabetics who are
instructed on diabetic complications and the
benefits of good control do get an exam with
diabetes as the only listed diagnosis and the
appropriate level E/M billed. I never had a
question about it. I have never been denied.

Bryan C. Markinson, DPM, NY, NY

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