Printer Friendly

Six-month interval for medicare coverage of foot exam questioned. (A 3-Month Cycle Might Be More Appropriate).

A new Medicare benefit that took effect July 1 is seen as a victory for patients with diabetic sensory neuropathy, but some experts are criticizing its 6-month coverage cycle.

The policy applies to diabetic patients who have peripheral neuropathy with loss of protective sensation (LOPS) but who do not currently have foot ulcers. They can undergo a foot exam every 6 months to allow for early intervention aimed at preventing serious complications. (See box.)

Dr. Lloyd Smith, vice president of the American Podiatric Medical Association, said in an interview that there is sufficient evidence to support exams every 3 months. "We believe that the 6-month cycle will put many of those patients at risk for complications such as amputation, infection, ulceration, and disability," said Dr. Smith, a podiatrist who practices in Boston.

Dr. Steve E. Phurrough, director of the division of medical and surgical services in the coverage and analysis group at the Centers for Medicare and Medicaid Services, Baltimore, said the decision to adopt a 6-month cycle was based on "not the greatest" scientific data. In fact, he said, most of the best available evidence comes from 1-year follow-up studies.

"We are willing at anytime to accept a reconsideration request [for a shorter evaluation period], but we need to see the evidence, and it's just not there," Dr. Phurrough told this newspaper.

Dr. Smith said that he and his associates "intend to submit additional evidence to CMS in that regard." And despite the concerns, Dr. Smith urged physicians to not lose sight of the fact that this is an important Medicare benefit.

"Like any other benefit that has a time limit: mammograms, Pap smears, and prostate exams," Dr. Phurroughs said, "beneficiaries will need to keep tabs on their benefit."

Dr. Phurrough noted that the policy emphasizes the importance of sensory testing with the 5.07 monofilament. "Just looking at the feet is a start, but it isn't adequate. You commonly miss peripheral neuropathy without doing the monofilament test."

To order "Performing Foot Exams to Prevent Lower Extremity Amputations in Patients with Diabetes," a 12-minute instructional video for health care professionals on conducting foot exams, call 888-691-9167 and ask for Jim Turpin. The cost is $5.35, including shipping.


Billing codes related to the policy include:

* G0245. Initial evaluation of a diabetic patient with LOPS:

* Diagnosis of LOPS.

* Patient history

* Total foot exam with evaluation of LOPS, foot structure, and biomechanics, vascular status, skin integrity, and evaluation and advice on footwear.

* Patient education.

* G0246. Follow-up evaluation of a diabetic patient with LOPS:

* Patient history.

* Total foot exam (as previously described).

* Patient education.

* G0247. Routine foot care of a diabetic patient with LOPS:

* Local care of superficial wounds.

* Debridement of corns and calluses.

* Trimming and debridement of nails.

G0247 must be billed on the same date of service with either G0245 or G0246 in order to be considered for payment.

Source: Centers for Medicare and Medicaid Services
COPYRIGHT 2002 International Medical News Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Internal Medicine News
Geographic Code:1USA
Date:Aug 15, 2002
Previous Article:Total contact cast optimal to heal diabetic foot ulcer. (Offloading Strategies).
Next Article:Chronic lung disease linked to cognitive loss. (Hypoxemia Likely Cause).

Related Articles
When Medicare no longer cares; how to take the pain out of the "medigap" that lies between federal assistance and actual costs of health care.
Legislation to close gaps in Medicare coverage of immunosuppressive drugs introduced in Senate, House.
Medicare to Cover Diabetic Podiatric Exam. (In Neuropathy).
CMS solutions to 5 of the 'Top 25' Hassles on the regulatory hit list.
Impact of Medicare managed care market withdrawal on beneficiaries.
Should medicare cover PET scans for Alzheimer's disease? (Pro & Con).
Medicare revises rules on covering ICD devices. (Cardiovascular Medicine).

Terms of use | Privacy policy | Copyright © 2022 Farlex, Inc. | Feedback | For webmasters |