How To Use HCPCS Code G0246

HCPCS code G0246 describes the follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops). This code is specifically used to identify the evaluation and management services provided to diabetic patients who have a loss of protective sensation in their feet. It includes a comprehensive assessment of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, foot structure and biomechanics, vascular status and skin integrity, as well as evaluation and recommendation of footwear. Additionally, patient education is an integral part of this service.

1. What is HCPCS G0246?

HCPCS code G0246 is a specific code used to identify the follow-up evaluation and management services provided to diabetic patients with diabetic sensory neuropathy resulting in a loss of protective sensation (lops). It is important to note that this code is only applicable for patients with this specific condition and should not be used for other types of evaluations or management services.

2. Official Description

The official description of HCPCS code G0246 is as follows: “Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least 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, and (e) evaluation and recommendation of footwear, and (3) patient education.” The short description of this code is “Followup eval of foot pt lop.”

3. Procedure

1. The provider begins by taking a detailed patient history, focusing on the diabetic patient’s foot health and any symptoms related to sensory neuropathy and loss of protective sensation.
2. A comprehensive physical examination is performed, which includes a visual inspection of the forefoot, hindfoot, and toe web spaces. The provider evaluates the condition of the skin, nails, and any deformities or abnormalities.
3. The provider assesses the patient’s protective sensation by using various tests and tools to determine the level of sensation loss in the feet.
4. Foot structure and biomechanics are evaluated to identify any issues that may contribute to the development or progression of diabetic sensory neuropathy.
5. Vascular status and skin integrity are assessed to ensure proper blood flow and to identify any signs of compromised circulation or skin breakdown.
6. Based on the evaluation findings, the provider makes recommendations for appropriate footwear to protect the patient’s feet and prevent further complications.
7. Lastly, patient education is provided to ensure the patient understands the importance of foot care, proper footwear, and the management of diabetic sensory neuropathy.

4. When to use HCPCS code G0246

HCPCS code G0246 should be used when providing follow-up evaluation and management services to a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops). It is important to ensure that the patient meets the specific criteria outlined in the code description, including the presence of diabetic sensory neuropathy and loss of protective sensation. This code should not be used for patients without these specific conditions.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0246, healthcare providers need to document the comprehensive evaluation and management services provided to the diabetic patient. This includes detailed documentation of the patient history, physical examination findings, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and the recommendations for footwear. Additionally, documentation of the patient education provided should be included.

6. Historical Information and Code Maintenance

HCPCS code G0246 was added to the Healthcare Common Procedure Coding System on July 01, 2002. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to note that this code has been in use for several years and has not undergone any significant changes or revisions.

7. Medicare and Insurance Coverage

HCPCS code G0246 is eligible for coverage by Medicare and other insurance providers. The pricing indicator code 11 indicates that the price for this service is established using national relative value units (RVUs). The multiple pricing indicator code A indicates that this code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to review the specific coverage guidelines of each insurance provider to ensure proper reimbursement for the services provided.

8. Examples

Here are five examples of when HCPCS code G0246 should be billed:

1. A diabetic patient with sensory neuropathy presents for a follow-up evaluation of their foot condition. The provider performs a comprehensive assessment of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and provides patient education on foot care and footwear recommendations.
2. A diabetic patient with a loss of protective sensation in their feet comes in for a routine follow-up visit. The provider performs a thorough evaluation of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and provides patient education on proper foot care.
3. A diabetic patient with sensory neuropathy is referred to a specialist for a follow-up evaluation of their foot condition. The specialist performs a comprehensive assessment of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and provides patient education on foot care and footwear recommendations.
4. A diabetic patient with a history of foot ulcers and sensory neuropathy visits their primary care physician for a follow-up evaluation. The physician performs a detailed assessment of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and provides patient education on wound care and proper footwear.
5. A diabetic patient with a loss of protective sensation in their feet seeks a second opinion from a podiatrist. The podiatrist conducts a comprehensive evaluation of the patient’s foot health, including a patient history, physical examination, evaluation of protective sensation, assessment of foot structure and biomechanics, evaluation of vascular status and skin integrity, and provides patient education on foot care and footwear recommendations.