As we approach the November Podiatry Management issue dedicated to diabetes mellitus, the issue of not addressing preventative care for this patient segment comes to mind. Great strides have been made in wound care with cellular tissue products, bone grafting materials, non-invasive circulatory testing, microbiologic testing, etc. Yet the single largest segment of diabetic patients has largely not been addressed. That is the segment of patients without patient-recognized symptoms, those who require screening for diabetic foot complications. 

Our colleague Paul Han, DPM, published a recent Health Affairs Scholar article called, “Underinvesting in prevention: the costly blind spot in US Diabetes Care”. Dr. Han will also have an article in the November PM issue on this same subject. In a personal communication with Dr. Han, he stated that 30 percent of the California Medicaid budget is spent on diabetic in-patient foot complications, yet only 1 percent total payment is spent on diabetic eye complications. This because there is an insufficient infrastructure for screening diabetic foot pathology and a robust structure for screening diabetic ophthalmological complications before requiring expense treatments, surgery, and/or hospitalization. 

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Regarding the original question and the ensuing conversation last week about the L3000 denials by Blue Cross Blue Shield of Texas, I made a mistake. The XS and the 59 modifiers should indeed not be used when billing for DME. Modifier XS and modifier 59 should be restricted exclusively for surgical or medical procedures.

I used ChatGPT to respond to the query. ChatGPT and the like can be accessed when researching certain issues, but you must use it carefully. It is not a solution that fixes every problem; though it can be helpful, it is not the answer to everything.

—Michael G. Warshaw, DPM, CPC

Question: While I know patients need to pay out-of-pocket for RFC if they don't have a qualifying diagnosis, can I request payment for services that would normally covered by Medicare? Specifically, can a physician request a patient pay for routine foot care from patients that have qualifying factors?

Response from Codinglinehelpline.com

No—not if the podiatrist/physician is enrolled in Medicare and the routine foot-care service actually meets Medicare’s coverage requirements. You generally cannot convert a Medicare-covered service into a cash-pay service simply because you would prefer not to bill Medicare or because the patient agrees to pay cash. CMS states that even if the beneficiary voluntarily refuses to authorize claim submission, Medicare’s limits on what the physician may collect still apply.

Scenario:

Patient does not meet Medicare's routine foot-care coverage criteria

Response:

Generally yes. The service is statutorily non-covered.

Scenario:

Patient does meet the systemic-disease/class-finding/other applicable coverage criteria

Response:

Generally no. An enrolled, non-opt-out provider should bill Medicare.

Scenario

You believe the normally covered service will be denied for medical-necessity reasons in this particular case

Response

Potential ABN situation; follow Medicare ABN rules.

Scenario

Physician/podiatrist has formally opted out of Medicare and has a valid private contract

Response

Different rules apply; cash payment for otherwise Medicare-covered services is permissible under the opt-out/private-contract framework.

Regarding ABN

An ABN is not a mechanism for turning a service that you expect Medicare to cover into a cash service. CMS explains that an ABN applies when the provider believes Medicare will not make payment for a service that otherwise may be covered. The patient can then elect to receive the service and accept financial responsibility if Medicare denies it. Conversely, when routine foot care is statutorily excluded because the patient does not meet a covered exception, an ABN is not required. CMS does encourage voluntary notice as a courtesy for services such as non-covered routine foot care.

—Alan Bass, DPM, CPC 

Additional coding and billing questions and responses can be found at www.Codinghelpline.com. To ask a question or add your thoughts, email [email protected].

What a Global Conference Revealed About the Future of Healing

We can image wounds with artificial intelligence, manipulate the wound microenvironment, engineer sophisticated tissue matrices, and deploy technologies that would have seemed unimaginable just a decade ago. Yet, despite these advances, one uncomfortable question remains: Are we getting better at treating wounds, or are we truly getting better at healing patients?

Walking away from the recent World Union of Wound Healing Societies (WUWHS) conference held Sept 23-26, 2026, in Kuala Lumpur, Malaysia, I was struck not only by the breadth of scientific innovation presented but also by an equally important undercurrent woven throughout the program: the need to reconnect technological progress with the realities of the patient experience. Perhaps the next great advancement in wound care won’t come from what we put on a wound, but from rethinking everything that happens around it.

—Windy Cole, DPM, CWSP

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I’m interested in expanding my professional partnerships in my area. This is about establishing a network of complementary medical providers (not necessarily just DPMs) who can share information, make patient and/or supplier referrals when appropriate, and so on. Does anyone have any advice about how best to get started with this and anything I should consider as I go?

—Name Withheld

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A 68-year-old man with type 2 diabetes and a healed plantar ulcer returns to clinic four weeks after a prolonged battle with wound closure. He mentions, almost in passing, that he “stumbled a bit” getting out of the shower last week. He didn’t fall, but for some reason, he mentioned it to me.

For most podiatrists, that near-miss barely registers alongside the more familiar checklist of diabetic foot surveillance: diabetes and co-morbidity management, shoes and inserts, activity level, neurologic and vascular status, education reinforcement, and nail and callus care. But the near-fall deserves equal evaluation and intervention consideration. Patients with diabetic peripheral neuropathy (DPN), especially those with a history of diabetic foot ulceration (DFU) or partial foot amputation, carry a fall risk that rivals their ulcer recurrence risk. Treating these as two separate problems, managed by two separate conversations or even separate providers, misses an opportunity that sits within the scope of podiatric medicine: much of what protects the foot from breakdown also protects the patient from falling, and vice versa.

Priced below appraisal. Established hospital-campus practice with strong referrals and 25,000 patient records. Fully equipped with digital X-ray and EMR. Staff staying on. Open four days, with demand for five. Retiring physician will assist with transition. A rare turnkey opportunity. Confidential inquiries: [email protected]

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