# corn treatment-Q7,Q8, and Q9



## misstigris (Jan 19, 2010)

I have a Medicare patient that keeps coming back to see the doctor for treatment of a corn. The note indicates that the corn is painful and the patient is Diabetic, however, there are no Diabetic manifestations noted in the progress note. The note indicates that the corn was shaved with a scapel and then cryo done (I am condensing the actual procedure note) I would use 11055 for the paring/cutting of the corn. What code would you use for the cryo? Would it be the 17110?

Also, can someone please help me with the Q7, Q8, and Q9 modifiers? I am having trouble finding clarification of the description of these codes and when appropriate to use them.

Thanks in advance for any help.


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## ciphermed (Jan 20, 2010)

In regards to the modifier's Q7,Q8 & Q9

The official descriptions can be found in HCPCS Level II manual. You may
also find information regarding the modifiers in the LCD and related article for routine foot care and debridement.

Here is some info. re: the modifier's extracted from the LCD & article (NGS contractor)

Modifiers:
One of the modifiers listed below must be reported with codes 11055, 11056, 11057, 11719, G0127, and with codes 11720 and 11721 when the coverage is based on the presence of a qualifying systemic condition, to indicate the class findings and site:
Modifier Q7: One (1) Class A finding
Modifier Q8: Two (2) Class B findings
Modifier Q9: One (1) Class B finding and two (2) Class C findings.
NOTE: If the patient has evidence of neuropathy, but no vascular impairment, the use of class findings modifiers is not necessary. This condition would be represented by the ICD-9 CM codes listed in the table below under “ICD-9 Codes that are Covered”.

Class A findings 
Non-traumatic amputation of foot or integral skeletal portion thereof

Class B findings 
Absent posterior tibial pulse 
Advanced trophic changes as evidenced by any three of the following: 
1.	hair growth (decrease or increase) 
2.	nail changes (thickening) 
3.	pigmentary changes (discoloring) 
4.	skin texture (thin, shiny) 
5.	skin color (rubor or redness) 
Absent dorsalis pedis pulse
Class C findings 
Claudication 
Temperature changes (e.g., cold feet) 
Edema 
Paresthesias (abnormal spontaneous sensations in the feet) 
Burning 
The presumption of coverage may be applied when the physician rendering the routine foot care has identified:
1.	A Class A finding
2.	Two of the Class B findings; or
3.	One Class B and two Class C findings.


http://www.cms.gov/mcd/viewlcd.asp?lcd_id=26426&lcd_version=29&show=all

Hope this helps,


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## TammyHF (Jan 20, 2010)

In the LCD for routine foot care the LCD states that routine foot care can only be provider once every 60 days. Our office schedules every 10 weeks to simplify it for the front desk. Also in the LCD for routine footcare it describes how to use the Q modifiers and what are the class findings. Here is a quick run down:

Q7 - 1 Class A Findings
Q8 - 2 Class B Findings
Q9 - 1 Class B Findings and 2 Class C Findings

Class A Findings 
* Non-traumatic amputation of foot or integral skeletal thereof

Class B Findings
* Absent posterior tibial pulse
* Absent dorsalispedis pulse
* Advance trophic changes such as (3 required)
- Hair growth decreased
- Nail changes
- Pigmentary changes (discoloration)
- Skin texture (thick, shinny)
- Skin color (rubor or redness)

Class C Findings
* Claudication
* Temperature (e.g. cold feet)
* Edema
* Paresthesias (abnormal spontaneous sensations in feet)

I have made this into a cheat sheet for the staff at our office. If a nail debridement is done the same day a 59 modifier will need to be used on the lesser charge. Just reminder some diagnosis will require the last date see by the treating MD/DO in the past six months. The LCD for your area will let you know. If cryo was done the correct CPT is 17110 or 17111 depending on the number of lesions. You can use both the 11055 and 17111 for remove the same lesion. You will need to pay attention to the diagnosis codes. For callus debridement CPT 11055 through 11057 a callus diagnosis is used ICD-9 700 but benign lesion destruction 17110 through 17111 ICD-9 700 callus diagnosis is not a medically necessary diagnosis.


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## misstigris (Jan 20, 2010)

thanks for the information. I knew that the 17110 wouldn't get covered, and I thought there needed to be more documentation than just indicating the patient had diabetes 250.00 to support medical necessity. Unfortuantely, I guess this will be a write off for the three visits that the physician treated it, but a great learning tool.


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## misstigris (Jan 27, 2010)

I reviewed the notes again, and on one of the encounters (the pt came in 3 separate times for this treatment) it indicates:

"Also, she has a painful corn on her right fifth toe. She has never had a corn before and because she is on Coumadin, she has been told that she can't use any of the OTC topical treatments" and pt is diabetic.

Would this justify medical necessity for the physician to treat it? and what modifiers could I use to indicate this? or use supporting dx?


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## TammyHF (Jan 28, 2010)

dx 700, 250.70, 729.5 and appropriate cardio diagnosis. As for the modifier you will need the appropriate QX modifier according to her notes.


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