How To Establish And Maintain A Diabetic Shoe Program

Author(s): 
By Jonathan Moore, DPM, MS and Kimberly Moore, OTR

If you as a podiatric physician have not established yourself as the expert of the diabetic foot within your area, now is the time. There is no reason why you shouldn’t be the “go to” guy or gal in your community when it comes to treating, managing and preventing diabetes-related lower extremity complications.
Managing the diabetic foot is all about a team approach and establishing yourself as the quarterback will not only improve the quality of care for your patients but it can also greatly enhance your business.
The podiatric literature is replete with dozens of studies demonstrating the correlation of foot pressures and ulceration. As the community foot and ankle specialist who reads and is aware of issues relating to pressure and ulceration prevention, you should ensure that diabetic shoes are an integral part of your “diabetic foot program.”

Six Key Points For Providing Diabetic Footwear
If shoes and inserts are not a part of how you manage your diabetic patients, consider the following points.
1. Pressure relief correlates to a reduced incidence of ulceration. Studies show ulceration precedes most amputations. Appropriate fitting inserts and supportive shoes can significantly reduce the risk of ulceration.
2. Poor, ill fitting shoes correlate to skin irritation and ulceration. If you aren’t looking at your patient’s shoes, you are missing a critical area of examination.
3. Who would you like dispensing shoes to your diabetic patients? A pharmacy? A local DME company or Charlie’s traveling diabetic shoe company? Don’t be a spectator when it comes to your patient’s shoes.
4. Providing a comfortable shoe that pads and protects your patient’s foot will make him or her a patient for life.
5. Make one patient happy with a pair of comfortable protective diabetic shoes and many more will come.
6. Medicare reimburses approximately $300 for one (off the shelf) pair of extra-depth therapeutic shoes and three sets of heat molded/custom multilaminar insoles. Your cost for shoes and inserts can range between $120 to $200. If you don’t provide shoes for your patients, someone much less qualified will.

As the cost of diabetes-related lower extremity complications has skyrocketed over the past decade, Medicare developed the diabetic shoe program with the idea of saving money by preventing ulcers. Although debate still looms over whether diabetic shoes can reduce the overall amputation rate, the bottom line remains that pressure and friction in a neuropathic diabetic patient lead to devastating consequences and there is no one better to address those issues than the podiatric physician.

An Overview Of The Medicare Shoe Bill
Diabetic patients with one or more of the following diagnoses may receive one pair of therapeutic shoes (A5500 x 2) and three pair of heat-moldable multilaminar inserts (A5509/ A5511 x 6) per year. A patient who received shoes August 6, 2003 will be eligible for another pair August 6, 2004.
Patients who are eligible for this shoe bill must have diabetes mellitus with an accompanying history of partial or complete amputation of the foot; a history of previous foot ulceration; a history of pre-ulcerative callus formation; foot deformity or poor circulation. For these patients, you should use the appropriate ICD-9 diagnosis codes 250.0 – 250.91.
As we all know, documentation is essential. Your documentation must include:
• a signed certificate of medical necessity (CMN);
• the shoe prescription (including size, style and required modifications);
• a statement that the heat moldable inserts achieve total contact;
• invoices from the shoe/insert order;
• a statement of fitting/pick-up; and
• notations of any adjustments you make at fitting.

Comments

Our most common complaints from patients is how bad their podiatrist fit them for diabetic shoes. If fact the podiatrist never did any measuring. The receptionist make the measurements. Then the podiatrists have the audacity the not except a return for poor fitting shoes. I have heard this countless times. This is why us "not as qualified" (ridiculous) pedorthists stay so busy with the therapeutic shoe bill.

However, this is a well written article nontheless.

Ha! Bravo to the previous commenter!

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