01/27/2022
LOPS Coding
My question is regarding "Foot-Care Services for Patients with Diabetic Sensory Neuropathy and LOPS" When if at all, would it be appropriate to use either G0245 or G0246 with or without an in-office visit code (992XX). example, beginning of the year - diabetic patient with neuropathy comes in for their nail care and you do a full pedal examination. Thank you
There isn’t one specific CPT or HCPCS code for billing a CDFE. Depending on the conditions that an individual patient presents at the time of an evaluation, there may be two possible ways to code for the exam:
- If the patient has LOPS associated with diabetes, there are two specific G codes that can be billed to an insurance carrier, depending on if the patient is new or established (HCPCS G0245 or G0246)
If the patient does not have LOPS, diabetes and any secondary conditions, then the exam should be billed with a new or established evaluation and management code depending on the level that was reached (99202-99215)
When billing for:
-G0245 (Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) or
-G0246 Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS), there are no time increments for these codes.
Either code is defined on criteria which must include the following:
1) a patient history,
2) a physical examination that includes:
(a) visual inspection of the forefoot, hindfoot and toe web spaces,
(b) evaluation of protective sensation
(c) evaluation of foot structure and biomechanics
(d) evaluation of vascular status and skin integrity
(e) evaluation and recommendation of footwear, a
(3) patient education
When billing an E&M, there are two main considerations that need to be taken into account:
- Is this a new patient (either initial visit to the practice, or an established patient who has been seen for at least three years) (99202-99205)?
- The level of service will depend on the amount of time and review of systems, depending on the assessment of the patient. Some patients may have a more straightforward review, and others will need more detail depending on other variables. (99212-99215).