Documentation Requirements for Diabetic Shoes and Inserts

THE FOLLOWING IS FOR INFORMATIONAL PURPOSES ONLY.

  1. Patient MUST be Diabetic
  2. Patient must have at least 1 of the qualify conditions:
    1. History of partial or complete amputation of the foot
    2. History of foot ulcer(s)
    3. History of Pre-Ulcerative Callus(es)
    4. Peripheral Neuropathy with Callus Formation (BOTH must be present)
    5. Foot Deformity (Bunion, Hammertoe, Pes Planus (flat feet), Pes Cavus (high arches), Amputation)
    6. Poor Circulation (High Blood Pressure, Noted Swelling, CAD, CHF, PAD, PVD, Venous Insuffiency) - Combination of 2 required
  3. What is the cause of swelling?

Doctors:

1. Please note any of the above qualifiers in your diabetic foot exam and assessment. Must note the order for diabetic shoes and inserts in the PLAN OF CARE.

2. DM follow-up visit by MD or DO (NO EXCEPTIONS) with A1C test results.