{"id":12847,"date":"2021-02-04T15:59:27","date_gmt":"2021-02-04T10:29:27","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=12847"},"modified":"2025-05-07T09:02:10","modified_gmt":"2025-05-07T09:02:10","slug":"billing-for-loss-of-protective-sensation-lops","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/billing-for-loss-of-protective-sensation-lops\/","title":{"rendered":"Billing for Loss of Protective Sensation (LOPS)"},"content":{"rendered":"

Loss of Protective Sensation (LOPS) Basics<\/h2>\n

Diabetic sensory neuropathy, or peripheral neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory neuropathy is an anatomically diffuse process primarily affecting autonomic and sensory fibers; however, distal motor findings may be present in advanced cases.<\/p>\n

Long nerves are affected first, with symptoms typically beginning insidiously in the toes and then advancing proximally. This leads to loss of protective sensation (LOPS), whereby a person is unable to feel minor trauma from chemical, mechanical, or thermal sources.<\/p>\n

When foot lesions are present, the reduction in autonomic nerve functions may also inhibit wound healing.<\/p>\n

Medicare Coverage for LOPS<\/h3>\n

Medicare covers, as a physician service, an evaluation (examination and treatment) of the feet once every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation, as long as the beneficiary has not seen a foot care specialist for some other reason in the interim.<\/p>\n

Reporting of this service requires, at minimum, a patient history, a physical examination (including visual inspection of the forefoot, hindfoot, and toe web spaces; evaluation of protective sensation; evaluation of foot structure and biomechanics; evaluation of vascular status and skin integrity; and evaluation and recommendation of footwear) and patient education.<\/p>\n

Medicare does not allow for separate payment of an E\/M code and a diabetic foot evaluation on the same date. Should you provide a diabetic foot exam to a patient with a documented diagnosis of diabetic sensory neuropathy and loss of protective sensation and not provide significant other E\/M services on the same date, it may be beneficial to report this using the codes for the diabetic foot evaluation and treatment.<\/p>\n

Applicable CPT Codes<\/h3>\n

The Medicare<\/a> Advantage Policy Guideline documents are generally followed by most of the commercial payers. They also follow Medicare guidelines such as LCDs, NCDs, and other Medicare manuals for the purposes of determining coverage. It is expected providers retain or have access to appropriate documentation when requested to support coverage.<\/p>\n

Some of the services that Medicare will cover for diabetics diagnosed with sensory neuropathy and LOPS include cutting or removal of corns and calluses; nail trimming, cutting, or debriding; and preventive maintenance foot care. These can be performed in the office, in an outpatient setting, or in the patient\u2019s home.<\/p>\n