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:
is clear evidence of significant circulatory changes
clinical record must identify the systemic condition (diagnosis) and the
size and exact location of each lesion treated
frequency of visits to perform foot care is reasonable
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
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.
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