Secrets To Billing For Diabetic Shoes

Marty Chalfin, CPed

Given the escalating prevalence of people with diabetes, chances are you will be seeing more and more patients in need of diabetic footwear. With this in mind, this author reviews recent changes in the Therapeutic Shoe Program for Diabetes and discusses how to navigate the paperwork trail to help ensure timely dispensing of shoes and appropriate reimbursement.

The Therapeutic Shoe Program for Diabetes (TSPD) was created to help prevent lower limb amputations and may very well be the only true preventative program Medicare offers. In order to offer this great benefit to your patients with diabetes — and be profitable in doing so — it is important to have a simple and efficient process in place to ensure you are compliant and prepared to avoid the headaches of a Medicare audit gone bad.

   Accordingly, let us take a closer look at a simple seven-document solution, tailored specifically to the DPM, which will help make you audit proof and allow you to avoid these potential headaches.

   Medicare has recently issued statements modifying the paperwork necessary to provide patients diabetic shoes and inserts under the TSPD. When it comes to the TSPD, what can make policy issues confusing is the somewhat unique nature of those who are allowed to supply diabetic footwear. A supplier can be a durable medical equipment company, a pharmacy, an orthotics and prosthetics (O&P) company, or a DPM practice. When Medicare issues policy statements regarding the TSPD, they try to explain how the process should go in one way that covers all of these different channels. The results can be pretty confusing.

   Of the various types of suppliers allowed to dispense diabetic footwear under the TSPD, the DPM practice is typically the only one having someone on staff qualified to make a diagnosis. This gives DPMs a distinct advantage. This advantage gives you the flexibility to meet Medicare’s requirements in several different ways. Rather than going through all the different options, let us take a look at one simple method to ensure you are always in compliance with the TSPD.

   Here are the seven simple pieces of paper you need.

1) Statement of certification
2) Note of diagnosis
3) Prescription
4) Notes during measuring
5) Packing slip
6) Notes during dispensing
7) Authorization for payment and warranty

   You would fill out the first three prior to ordering shoes. You and your staff would gather the remaining four documents during the process of fitting and dispensing the shoes to the patient. The KX code in the billing process signifies that you have the information contained in these documents on file. Keep these seven pieces of paper in the patient’s chart so you can easily retrieve them as a group if Medicare or the insurance carrier asks for them.

   The following is a description of each of these documents, their purpose and some hints in obtaining these documents painlessly.

   1) Statement of certification. This is a single-page standard document in which the MD or DO states: that the patient has diabetes (ICD Code); that the patient has one or more of six qualifying conditions; and that the patient would benefit from diabetic shoes and inserts under the TSPD.

   The qualifying conditions are simply listed as:

• history of partial or complete amputation of the foot;
• history of previous foot ulceration;
• history of pre-ulcerative callus;
• peripheral neuropathy with evidence of callus formation;
• foot deformity; and/or
• poor circulation.

   Remember that the TSPD is a proactive program that will save limbs by giving patients shoes before they have serious issues. By signing the statement of certification, the MD/DO is actually ordering the supplier to dispense the footwear to the patient.

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