Documenting Therapeutic Shoes

Remember that MasterCard commercial? “MasterCard. It's everywhere you want to be.” It's the same with documentation. Every product category you want to provide to assist in the growth of your business has associated documentation requirements. Maybe our new slogan should be “Documentation. It's everywhere you want to be.”

For example, many providers have added therapeutic shoes for diabetics in recent years, but there are strict Medicare documentation requirements associated with providing the product. In order for these items to be covered for your patient, the following criteria must be met:

An M.D. or D.O. (termed the “certifying physician”) must be managing the patient's diabetes under a comprehensive plan of care and must certify that the patient needs therapeutic shoes. The certifying physician must document that the patient has one or more of the following qualifying conditions:

• Foot deformity

• Current or previous foot ulceration

• Current or previous pre-ulcerative calluses

• Previous partial amputation of one or both feet or complete amputation of one foot

• Peripheral neuropathy with evidence of callus formation

• Poor circulation

According to Medicare national policy, it is not sufficient for a podiatrist, physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) to provide that documentation (although they are permitted to sign the order for the shoes and inserts). The certifying physician must be an M.D. or D.O.

The following physician documentation is required in order for Medicare to pay for therapeutic shoes and inserts and must be provided by the physician to the supplier, if requested:

1. A detailed written order.

2. A copy of an office visit note from the patient's medical records that shows the physician is managing the patient's diabetes. This note should be within six months prior to delivery of the shoes and inserts.

3. Either (a) a copy of an office visit note from the physician's medical records that describes one of the qualifying conditions or (b) an office visit note from another physician (e.g., podiatrist) or from a PA, NP or CNS that describes one of the qualifying conditions. If option (b) is used, the certifying physician must sign, date and make a note on that document indicating their agreement and send that to the supplier.