05/08/2026    Joseph Borreggine, DPM

The Benefits from the Proper Use of E/M Codes

Last evening, I attended a webinar presented by
Allen Jacobs DPM. This webinar had a follow-up
lecture with Dr. Michael Warshaw a retired
podiatrist from Florida, a leading Medicare
consultant who evaluates audits conducted on
podiatry practices. Dr. Warshaw provided CMS
policy and information to support every claim made
by Dr. Jacobs, ensuring the accuracy and validity
of his information provided.

Dr. Jacobs, as we know, is an esteemed and
respected podiatrist with over 50 years of
experience in the field, shared insights that have
been beneficial to my podiatric practice and E/M
coding.

Interestingly, during my tenure as a podiatrist, I
encountered a situations where I had seen other
colleagues was using the E/M codes as their
primary CPT code along routine foot care performed
in offices and long term care facilities that were
being serviced. While I disagreed with this
approach, many did consistently emphasize the
importance of identifying pathology. Initially, I
struggled to comprehend his perspective, but
further investigation, research and clarification
from other colleagues revealed that they were
actually advocating for a comprehensive evaluation
and management approach.

As podiatrists, we sometimes tend to minimize our
efforts on patients, assuming that our expertise
is sufficient without the need for a formal
medical diagnosis. This approach has proven
detrimental to our ability to provide effective
routine foot care including management of other
co-morbidities affecting the feet and lower
extremity.

The financial rewards associated with adhering to
the necessary E/M coding guidelines established by
the AMA in 2021 and updated in 2023 for long-term
care facility E/M codes are substantial.
Unfortunately, many podiatrists who provide
routine foot care to a significant portion of
their patients do not follow these guidelines,
either due to a lack of understanding or fear of
Medicare audits. It is important to note that both
of these concerns are unfounded, especially
considering the ability of podiatric physicians to
provide the necessary care to our patients and
prevent further complications.

Consequently, at-risk foot care poses a
significant risk to patients. As the primary
safeguard, we are responsible for preventing
further complications that could arise if left
unattended. Over the years, I have observed that a
majority of my diabetic patients, as well as those
with qualifying diagnoses such as neuropathy,
require at-risk foot care in both office settings
and long-term care facilities. Each of these
patients has undergone an evaluation and
management code assignment for their foot care
services, based on additional pathologies or
conditions identified.

Therefore, I intend to continue providing at-risk
foot care to patients along with added evaluation
and management of identified pathologies. Based on
this premise, I have had the need to reduce the
number of patients I see per visit, but maintain
the same income or exceed it seeing the typical
patient load. This could potentially increase the
frequency of visits to ensure comprehensive
coverage of an improve the patient prognosis.
Therefore, I will continue to maintain the current
schedule of patients to be seen and monitor the
outcomes to prevent future issues.

This webinar provides further support for my
decision to continue providing at-risk foot care
on qualified patients along with the ethical use
evaluation and management services backed up with
appropriate documentation.”

Joseph Borreggine, DPM, Fort Myers, FL

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