Modifiers Q7, Q8, and Q9 - c.ymcdn.com

1 1 - 472007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)Copyright 1996 to 2007 - Inga Ellzey Practice Group, Inc. (IEPG). All rights codes, descriptions, and numeric Modifiers only are copyrighted 2006 American Medical Association. All Rights Q7, Q8, and Q9(Routine Foot Care)CPT ModifierQ7 One Class A findingQ8 Two Class B findingsQ9 One Class B and two Class C findingsGeneral InformationThe Office of Inspector General (OIG) recently studied the appropriateness of Medicare naildebridement payments, which is the single largest paid podiatric service.

2 The OIG found that aboutone in every four claims did not include documentation of medical need for nail debridement inbeneficiaries medical records and that more than half of these inappropriate payments includedother related inappropriate payments. This article explains the requirements for payment ofMedicare claims for foot and nail services including information about routine foot care exclusion,exceptions to routine foot care exclusion, Class Findings, billing instructions, required claiminformation, and documentation on Foot Care ExclusionExcept as noted in Exceptions to Routine Foot Care Exclusion section, routine foot care isexcluded from coverage.

3 Services that are normally considered routine and not covered byMedicare include:1. The cutting or removal of corns and calluses;2. The trimming, cutting, clipping, or debriding of nails; and3. Other hygienic and preventive maintenance care such as cleaning and soaking the foot, useof skin creams to maintain skin tone of either ambulatory or bedfast patients, and any otherservice performed in the absence of localized illness, injury, or symptoms involving the - 482007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)Copyright 1996 to 2007 - Inga Ellzey Practice Group, Inc.

4 (IEPG). All rights codes, descriptions, and numeric Modifiers only are copyrighted 2006 American Medical Association. All Rights to Routine Foot Care Exclusion1. Services performed as a necessary and integral part of otherwise covered services such asdiagnosis and treatment of ulcers, wounds, infections, and The presence of a systemic condition such as metabolic, neurologic, or peripheral vasculardisease that may require scrupulous foot care by a professional. Certain procedures that areotherwise considered routine may be covered when systemic condition(s), demonstratedthrough physical and/or clinical findings, result in severe circulatory embarrassment or areasof diminished sensation in the legs or feet and may pose a hazard if performed by a non-professional person on patients with such systemic conditions.

5 In the case of patients withsystemic conditions such as diabetes mellitus, chronic thrombophlebitis, and peripheralneuropathies involving the feet associated with malnutrition and vitamin deficiency, carci-noma, diabetes mellitus, drugs and toxins, multiple sclerosis, and uremia, they must also beunder the active care of a doctor of medicine or doctor of osteopathy and who documents thecondition in the patient s medical Services performed for diabetic patients with a documented diagnosis of peripheral neuropa-thy and loss of protective sensation (LOPS) and no other physical and/or clinical findingssufficient to allow a presumption of coverage as noted in the Medicare Carriers Manual.

6 Thisclass of patients can receive an evaluation and treatment of the feet no more often than everysix months as long as they have not seen a foot care specialist for some other reason in theinterim. LOPS shall be diagnosed through sensory testing with the monofilament usingestablished guidelines, such as those developed by the National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK) guidelines. Five sites should be tested on the plantarsurface of each foot, according to NIDDK Treatment of warts, including plantar warts, may be covered. Coverage is to the same extentas services provided for in treatment of warts located elsewhere on the Treatment of mycotic nails for an ambulatory patient is covered only when the physicianattending a patient s mycotic condition documents in the medical record that (1) there is clinicalevidence of mycosis of the toenail and (2)

7 The patient has marked limitation of ambulation, pain,or secondary infection resulting from the thickening and dystrophy of the infected toenail of mycotic nails for a non-ambulatory patient is covered only when the physicianattending a patient s mycotic condition documents in the medical record that (1) there is clinicalevidence of mycosis of the toenail and (2) the patient suffers from pain or secondary infectionresulting from the thickening and dystrophy of the infected toenail :Active care is defined as treatment and/or evaluation of the complicating disease processduring the six-month period prior to rendition of the routine care or had come under suchcare shortly after the services were furnished, usually as a result of a - 492007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)Copyright 1996 to 2007 - Inga Ellzey Practice Group, Inc.

8 (IEPG). All rights codes, descriptions, and numeric Modifiers only are copyrighted 2006 American Medical Association. All Rights FindingsA presumption of coverage may be made by Medicare where the claim or other evidence availablediscloses certain physical and/or clinical findings consistent with the diagnosis and indicative ofsevere peripheral involvement. For the purposes of applying this presumption, the followingfindings are pertinent:Class A Findings (1 needed)Non-traumatic amputation of foot or integral skeleton portion modifier B Findings (2 needed)1. Absent posterior tibial pulse2. Absent dorsalis pedis pulse3.

9 Advanced trophic changes; three of the following are required: hair growth (decrease or absence) nail changes (thickening) pigmentary changes (discoloration) skin texture (thin, shiny) skin color (rubor or redness)Use modifier C Findings (1 Class B, 2 Class C needed)1. Claudication2. Temperature changes3. Edema4. Paresthesia5. BurningUse modifier - 502007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)2007 - Complete Coder Office Suite (CPT Module)Copyright 1996 to 2007 - Inga Ellzey Practice Group, Inc.

10 (IEPG). All rights codes, descriptions, and numeric Modifiers only are copyrighted 2006 American Medical Association. All Rights InstructionsThe following are the main HCPCS/CPT codes for billing of foot and nail care services (additionalcodes can be found in the HCPCS/CPT code book):11719 Trimming of non-dystrophic nails, any number11720 Debridement of nail(s) by any method(s); one to five11721 Debridement of nail(s) by any method(s); six or more11730 Avulsion of nail plate, partial or complete, simple; single11732 Avulsion of nail plate, partial or complete, simple; each additional nail plate (listseparately in addition to code for primary procedure)Routine foot care is covered for the following diagnoses only:1.