Podiatric Medicine
Podiatric medicine is a branch of the health sciences
devoted to the medical and surgical care of the foot and ankle, and related
or governing structures. A doctor of podiatric medicine (DPM) specializes in
the prevention, diagnosis, and treatment of foot and ankle disorders
resulting from injury or disease. A DPM makes independent medical judgments,
prescribes medications, and when necessary performs surgery.
Podiatrists help our aging population to remain active and
independent by keeping them ambulatory. Congress recognized this important
relationship between foot health and general health when it included the
services of podiatric physicians in the Medicare legislation.
Misconceptions of Medicare
Medicare coverage can often be confusing. The rules and
regulations can easily be misunderstood by patients. One misconception is
that Medicare covers only surgical procedures, and not medical care or
routine foot care.
In truth, Medicare will cover routine foot care. According
to the Medicare Rules and Regulations Manual, "Certain foot care procedures
that are generally considered to be routine -- e.g., cutting or removal of
nails, calluses or corns -- may pose a hazard when performed by a
nonprofessional person on patients with a systemic condition that has
resulted in severe circulatory problems or areas of desensitization in the
legs or feet. Routine foot care performed under these circumstances is
covered."
The manual also states, "Services ordinarily considered
routine are also covered if they are performed as a necessary and integral
part of otherwise covered services such as the diagnosis and treatment of
diabetic ulcers, wounds, and infections."
Treatment of diabetic foot conditions, both medically and
surgically, is therefore covered by Medicare. Treatment of broken toes, of
burns, and of arthritic conditions -- gout, for example -- are others. (The
misconceptions that Medicare covers only surgery may be caused by the fact
that the Medicare code numbers assigned to diabetic treatment such as that
mentioned in the manual, and other nonsurgical procedures, are listed under
the "surgical" section of the code book.)
Coverage Under Medicare
If you have signed up for medical insurance (Part B) under
Medicare, you are covered for certain services of podiatrists and other
doctors for:
- Medical and surgical services in the hospital, skilled nursing
facility, office, or your home. The same action also provided that
podiatrists can certify and recertify medical necessity for
hospitalization, skilled nursing care, and home health care.
- Payment for routine foot care may be made for such care only when it
would be hazardous to the health of the patient if self-treatment were
performed. For example, when a beneficiary is under the care of a doctor
for diabetes, circulatory ailments or certain other conditions, and
evidences complicating local symptoms, routine foot care is a covered
service.
- Other prescribed health services, including diagnostic x-ray,
surgical treatment, fracture casts, and leg or ankle braces that are
attached to the outside of the shoe.
- Drugs which cannot be self-administered, and which are administered
to you as a part of professional services.
- Full reasonable charges for radiology and pathology services as a
bed patient in a hospital, if you have both hospital and medical
insurance.
Certain foot care services are not covered, no matter whether they are
performed by podiatrists, medical doctors, or osteopaths. They are:
- Routine foot care. This includes the cutting or removal of corns or
calluses, trimming of nails, and routine hygienic care, except as noted
above.
- Treatment of flat-foot conditions, including arch supports.
- Treatment of partial dislocations.
Reimbursement Under Medicare
Your medical insurance (Part B of Medicare) helps pay for
the services of podiatrists and other doctors, out-patient hospital
services, medical services and supplies, and other health care services.
Subscribers to medical insurance pay a monthly premium, and
the Federal government covers the remaining costs of the program. Medical
insurance pays 80 percent of the Medicare-allowed amount, after the
individual pays an annual deductible for covered services connected with the
diagnosis or treatment of illness and injuries. Payment for services of a
podiatrist or another doctor can be made as follows:
- 1. If you and your podiatrist agree, application for the medical
insurance payment for covered services will be made by the podiatrist
who will receive the payment directly from Medicare.
- If you desire it, you may pay the doctor directly, and the medical
insurance payment can be made directly to you.
In either case, you are responsible for the annual deductible and the
20 percent coinsurance amounts. Under either of these two payment options,
the podiatrist is required to complete the necessary Medicare claim forms
for you.
Note that, in some cases, you may also be charged amounts in
excess of the Medicare-allowed fees, and for services not covered under the
Medicare program.
See "Your Medicare Handbook" for more information.
Prompt Care Of Foot Disorders
With advancing years, the skin and nails of the feet
frequently become dry and brittle, and numbness and discoloration often are
present. These may be the first signs of such serious conditions as
diabetes, arthritis, and circulatory disease. Ignoring these symptoms and
failing to seek prompt professional medical care when they appear can have
serious consequences for patients, especially the elderly.
Foot Problems Can Be Prevented
Whether the older person lives at home or elsewhere,
preventive foot care can:
You may receive treatment from your podiatrist in the
office, your home, the hospital, a nursing home, or an extended care
facility. Always consult your podiatrist when you have questions about foot
conditions or what is covered by Medicare.
