03/27/2026    Joseph Borreggine, DPM

Why does an insurance company require high limits of liability for providers who are being credentialed?(Allen M. Jacobs, DPM)

Our esteemed podiatric colleague has once again
provided us with a highly insightful response to a
query regarding the significance of due diligence
even when providing benign services such as
routine foot care in long-term care facilities.

For years, podiatrists have provided foot care to
the elderly in nursing homes, assuming that the
services they offer are considered low-risk and
have minimal exposure to potential liability in
the context of malpractice. However, this
assumption may no longer be accurate.

Dr. Jacobs’ response emphasizes that while
podiatrists adhere to the Medicare LCD and routine
foot care policies to secure reimbursement based
on medical necessity and supporting documentation,
they may inadvertently become entangled in a
broader web of litigation related to their care
and treatment.

Routine foot care, as defined by the Medicare
policy, is merely a routine service. However, Dr.
Jacobs argues that this definition may be
misleading. Over the years, routine foot care has
been reclassified as “at-risk” foot care, which
Dr. Jacobs asserts is the primary reason for its
provision by podiatrists.

However, as Dr. Jacobs emphasizes, the class
findings and qualifying diagnoses required to
provide these services may be repeatedly
overlooked since podiatrists are primarily
concerned with ensuring their presence to receive
a modest financial benefit, which may be
associated with higher liability due to the
location of service.

This situation essentially leads to the next step
in protecting podiatrists from the possibility of
being directly or indirectly involved in a
malpractice case, regardless of carrying the
appropriate higher limits of liability required to
perform these foot care services. While it is
crucial to adhere to Medicare policies when
providing routine foot care, it should extend
beyond mere technical service provision.

The podiatrist, a physician and specialist, has
been alluded to by Dr. Jacobs in numerous other
responses in PMnews. Therefore, they should not
only provide this routine and necessary service
but also conduct a comprehensive evaluation and
management beyond the scope of the CPT code(s)
used for routine foot care.

This necessitates the use of the -25 modifier to
append the appropriate E/M code based on medical
decision-making or the time required to treat the
most likely physical pathology present at the time
of service. This pathology is typically observed
and noted but not treated due to various reasons,
such as the patient not being seen again for over
two months or a referral is not being generated
for necessary follow-up.

The podiatrist, who is the treating physician for
these foot care patients and likely sees them more
frequently than the primary care provider. The
lower extremity and foot are prone to pathology,
especially considering the patient demographic in
a long-term care facility, which includes a high
risk of falls, foot ulcers, venous wounds,
lymphedema, circulatory, and/or other
dermatological conditions, as eloquently mentioned
by Dr. Jacobs in his response.

Consequently, it is the podiatrist’s
responsibility to not only evaluate these issues
but also manage them effectively. By doing so, the
podiatrist can reduce their exposure to potential
lawsuits that may arise directly or indirectly due
to the care they provide. Negligence, even benign,
is not an excuse when it comes to the proper care
and treatment of a patient.

Joseph Borreggine, DPM,, Fort Myers, FL

Other messages in this thread:

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03/27/2026    Joseph Borreggine, DPM

Why does an insurance company require high limits of liability for providers who are being credentialed?(Allen M. Jacobs, DPM)

Our esteemed podiatric colleague has once again
provided us with a highly insightful response to a
query regarding the significance of due diligence
even when providing benign services such as
routine foot care in long-term care facilities.

For years, podiatrists have provided foot care to
the elderly in nursing homes, assuming that the
services they offer are considered low-risk and
have minimal exposure to potential liability in
the context of malpractice. However, this
assumption may no longer be accurate.

Dr. Jacobs’ response emphasizes that while
podiatrists adhere to the Medicare LCD and routine
foot care policies to secure reimbursement based
on medical necessity and supporting documentation,
they may inadvertently become entangled in a
broader web of litigation related to their care
and treatment.

Routine foot care, as defined by the Medicare
policy, is merely a routine service. However, Dr.
Jacobs argues that this definition may be
misleading. Over the years, routine foot care has
been reclassified as “at-risk” foot care, which
Dr. Jacobs asserts is the primary reason for its
provision by podiatrists.

However, as Dr. Jacobs emphasizes, the class
findings and qualifying diagnoses required to
provide these services may be repeatedly
overlooked since podiatrists are primarily
concerned with ensuring their presence to receive
a modest financial benefit, which may be
associated with higher liability due to the
location of service.

This situation essentially leads to the next step
in protecting podiatrists from the possibility of
being directly or indirectly involved in a
malpractice case, regardless of carrying the
appropriate higher limits of liability required to
perform these foot care services. While it is
crucial to adhere to Medicare policies when
providing routine foot care, it should extend
beyond mere technical service provision.

The podiatrist, a physician and specialist, has
been alluded to by Dr. Jacobs in numerous other
responses in PMnews. Therefore, they should not
only provide this routine and necessary service
but also conduct a comprehensive evaluation and
management beyond the scope of the CPT code(s)
used for routine foot care.

This necessitates the use of the -25 modifier to
append the appropriate E/M code based on medical
decision-making or the time required to treat the
most likely physical pathology present at the time
of service. This pathology is typically observed
and noted but not treated due to various reasons,
such as the patient not being seen again for over
two months or a referral is not being generated
for necessary follow-up.

The podiatrist, who is the treating physician for
these foot care patients and likely sees them more
frequently than the primary care provider. The
lower extremity and foot are prone to pathology,
especially considering the patient demographic in
a long-term care facility, which includes a high
risk of falls, foot ulcers, venous wounds,
lymphedema, circulatory, and/or other
dermatological conditions, as eloquently mentioned
by Dr. Jacobs in his response.

Consequently, it is the podiatrist’s
responsibility to not only evaluate these issues
but also manage them effectively. By doing so, the
podiatrist can reduce their exposure to potential
lawsuits that may arise directly or indirectly due
to the care they provide. Negligence, even benign,
is not an excuse when it comes to the proper care
and treatment of a patient.

Joseph Borreggine, DPM,, Fort Myers, FL