1) Determine the number of patients in practice who have diabetes (250.xx diagnosis).
2) Provide patient educational materials to raise awareness of diabetic preventative foot care.
3) Educate referring physicians about Medicare’s Therapeutic Shoe Program, requirements for their signature and return of Statement of Certifying Physician and report of Comprehensive Diabetic Foot Exam.
4) Determine staffing requirements for scheduling all patients with diabetes for Comprehensive Diabetic Foot Exams. Hire and train additional help as needed.
5) Provide established patients with diabetes information about the importance of the Comprehensive Diabetic Foot Exam and schedule an appointment separate from the routine foot care.
6) Perform CDFE, satisfying requirements for PQRS measures 126,127 and 163. Submit to Medicare using procedure codes G8404, G8410, and 2028F. Consider billing for CDFE as 99213 to satisfy requirements for items covered and time spent. For further explanation of CDFE, see article by Kenneth Malkin, DPM, “A Guide to Review of Systems”, www.docstoc.com/docs/3419459/AGuide-to-the-Review-of-Systems-Kenneth-F-Malkin.
7) At CDFE visit, if patient meets Medicare requirements for therapeutic footwear, select a size and style based on the patient’s risk categorization and aesthetic considerations. Shoe fitting is best accomplished by having the patient try on shoes from a fitting inventory. Patients who cannot be satisfactorily fit in depth shoes must be fit with custom-molded shoes. Podiatrists may cast and order these themselves or alternatively refer patients to an outside facility.
8) Write prescription for therapeutic shoes and accommodative inserts.
9) Use service to send to the Certifying Physician a copy of the Statement of the Certifying Physician AND the report of findings from CDFE. It is required to obtain from the Certifying Physician signed copies of both documents. Podiatrists as physician/suppliers are permitted to send findings of CDFE with diagnoses to the certifying physician to satisfy requirements that the MD / DO have documented in their own chart the condition(s) that qualify the patient for footwear.
10) Schedule patient to return for fitting of shoes and therapeutic inserts
after required compliance documentation has been received from the certifying physician. At the time of shoe fitting, pre-fabricated inserts are heat-molded to the shape of the patient’s feet, and the patient is advised of supplier standards, break-in instructions, and warranty information. The patient signs a certificate of receipt. Shoe fitting may be refined by the addition or removal of sizing spacers.
12) Provide patient education and emphasize the importance of daily patient foot examination.
13) Schedule the patient for a follow-up visit.