Many agencies have an RN perform foot care on diabetic patients or those with peripheral vascular disease. These ­agencies view foot care as a procedure requiring the skills of a nurse, thereby qualifying the patient for Medicare coverage. That is not a correct assumption.

When deciding how to care for diabetic patients' feet, look at Medicare coverage guidelines. Medicare doesn't cover routine foot care, which is defined as cutting or removal of corns or calluses; trimming, cutting, clipping, or debriding of nails; hygienic and preventive maintenance care such as cleaning and soaking the feet and application of skin creams to maintain skin tone of ambulatory or bedfast patients; and any other ­service performed in the absence of localized illness, injury, or symptoms involving the foot.

Foot care, even for a diabetic patient, doesn't always require nursing skills. However, there are exceptions. If a medical condition places the patient at increased risk of infection and/or injury when a nonprofessional provides these services, Medicare would then recognize that patient's foot care as requiring the skills of a nurse.

Exceptions to the definition of routine foot care are as follows:

• There is clear evidence of significant circulatory changes
• The clinical record must identify the systemic condition (diagnosis) and the size and exact location of each lesion treated
• The frequency of visits to perform foot care is reasonable
• The patient has a systemic condition, such as a metabolic, neurologic, or peripheral vascular disease, that may result in severe circulatory embarrassment or areas of diminished sensation in the individual's legs or feet 

The diabetic foot care process measures (M225, M2400) can be applied to show the best practice of assessing all diabetic patients' feet, but not all diabetic foot care is a qualifying covered service.