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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.

RELATED ARTICLE: Billing Codes

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
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Publication:Internal Medicine News
Geographic Code:1USA
Date:Aug 15, 2002
Words:490
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