Josh White, DPM, CPed
Failure to submit Medicare MIPS quality measures will cost physicians tens of thousands of dollars. In 2018, the penalty for not meeting the requirement is 5% of 2020 Medicare payments; this increases to 9% in 2020. Podiatrists should appreciate that performing MIPS Measures 126 and 127 of a diabetic ulcerative risk assessment can allow billing for an office visit and will increase awareness of when shoes and inserts, payable by Medicare, should be prescribed.
Podiatrists should annually perform a comprehensive diabetic foot exam on every patient with diabetes. A CDFE should include testing for loss of protective threshold using a 10-gram monofilament plus at least one of the following neurological exams including: feeling vibration using a tuning fork, pinprick sensation, or ankle reflexes. Testing should also look for vascular, dermatological and structural findings. The foot should be sized using a standard measuring device, and the patient counselled on appropriate footwear based on risk categorization.
MIPS quality measures 126 and 127, diabetic foot exam including evaluation of footwear, address the association of neuropathy with diabetic foot ulceration.
When patients with diabetes are given a comprehensive diabetic foot exam and provided a plan of care, which may include prescribing shoes, consider billing E&M code 99213. Also submit codes G8404 for MIPS 126 and G8410 for MIPS 127.
By identifying people who qualify for shoes paid for by Medicare, podiatrists can make shoe fitting a valuable part of their practice.