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01/18/2017

E & M Visits-Coding for Diabetic Patient Without Complications

Follow up to my recent diabetic foot exam question. When you say "Patients do not need to have another chief complaint in order to be seen for a diabetic foot evaluation or re-evaluation." Are you also talking about a healthy diabetic patient ? One who has E10.9 or E11.9 without complications. Is an E&M visit payable with just these codes? If yes, how often? Thank you.

In the case, that a diabetic patient doesn’t have a chief complaint during a foot evaluation or reevaluation , the LOPS codes only need to be reported with one of the following codes specified. No other codes are needed to justify medical necessity. It is not advised that an E&M code be billed with only a diabetic diagnosis code, even if it is a different ICD-10 code than the one used to bill for LOPS. Since podiatrists do not manage the patient’s condition, as would their PCP or specialist like an endocrinologist and only treat limited issues associated with diabetes, another diagnosis/condition would need to be billed with an E&M code (such as an ulcer, cellulitis, etc.). It should not be billed as the sole diagnosis.  

The codes are listed below for your reference:

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