# new to podiatry



## bwerner (Dec 16, 2009)

Our clinic has a new Podiatrist and I'm trying to learn a little about it. I've been reading some of the forums and I've seen some info regarding the Q modifiers, so I looked them up. What are they talking about One class findings, two class findings etc. Do I understand this right...you use Q modifiers on the procedures when there is a vascular diagnosis?

Any help with this would be great, I spent the majority of the day on the wonderful medicare website printing off my LCD & NCD's.

Oh..he asked me to find out any info regarding follow up's for.. I believe routine footcare every 62 days???? I can't find anything regarding this, does anyone know what he's talking about. 

Time to go home!!

Becky


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## TammyHF (Dec 17, 2009)

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 is 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)
* Burning 

I have made this into a cheat sheet for the staff at our office.


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## mariak81586 (Jan 21, 2010)

Hi Becky,

Here are some helpful tips concerning podiatry specifically routine care foot care:

You use a Q modifier with CPT codes 11055-11056: paring, cutting, shaving of lesions and 11719-11721: debridement of nails. Do not use a Q modifier when one of the diagnoses is for pain in the limb, 729.5.

Only use it for patients with Medicare primary and some Medicare Advantage plans. I know Sterling Options and Aetna Advantage plans follow the same rules Medicare does, but check with your state.

Although, I do not code for these podiatrists (bill for them, off location); I've found Q9 to be the most common modifier used. Q8 I've seen in only one or two patients they regularly see. Never seen Q7 used.

According to Medicare guidelines, routine foot care can be performed every 60 days. If it is less than 60 days, make sure the patient signs an ABN. If not, the patient is not responsible for paying for the services if Medicare denies, which they 100% automatically do.

Follow and pay close attention to those covered diagnosis codes on the LCD. The majority of the patients that see my podiatrists have diabetes or atheroscerlosis of the extremities. Usually these chronic conditions will be secondary diagnosis for the encounter and Corns, calluses (700) or dermatophytosis of the nails (110.1) will be the first.

Any diabetic patient who receives routine foot care must see their primary care physician within 6 months before the date of service. You must have the PCP's NPI# and date last seen on the claim form. This only applies with Medicare.

Do not code an office visit, not unless it is for a completely different reason other than routine foot care. 

I've been billing podiatry for six months now and as long as you have the rules down it becomes "routine". 

Hope this helps! 

-Maria, CPC-A


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## TammyHF (Jan 22, 2010)

Becky,

I want to clarify a few items that Maria posted. With diagnosis 729.5 some Medicare J-MAC requires the Q modifier. For the office I code for our Medicare carrier requires the Q modifier. From the LCD that applies to the state of Kansas "CPT codes: 11720, 11721 ICD-9 CM code 110.1 or 703.8 must be reported as primary condition and the appropriate Q modifier showing that a coverage criterion has been met." On the Q modifiers we tend to bill most often Q8 then Q9. As for the Q7 it is the least most common but at the office I work for we have about 20 patients that have non traumatic foot amputations. As for reporting last date seen by primary care physician for a diabetic, you can report that date last seen by the treating physician for the condition which for is seeing a specialist for. A diabetic could be an endocrinologist or nephrologist and not have a primary care physician. There are other conditions that require the 6 month report date such as 446.7 Takayasu's disease, 453.9 embolism and thrombosis of unspecified site, 585.5-585.6 chronic kidney disease, stage V- end stage renal disease, 795.39 other nonspecific positive culture findings, V12.50-V12.59 personal history of unspecified circulatory disease, V58.61 long term use of anticoagulants, 030.0-030.9 leprosy, 042 HIV, 045.10-045.13 polio, 088.81 Lyme disease... the list goes on. It is important to corectly code according to patient's medical history. I have been coding podiatry for over 8 years now. Please contact me if you can not find your LCD for your area or you have any further questions.


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## carminny (Feb 2, 2014)

*how do I look for the LCD*

Hi TammyHF, I will starting to code for a podiatrist and I came to look on reviews about this specific specialty, but since I do not know yet which state I will be coding for I would like to know how do I search for the LCD.  Also since your last post are from 2010 I would like to know if is anything change since that time.

Thanks for your help.


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## greendm (Feb 9, 2014)

Tammy,  My name is Dawna Moore..I started billing for Podiatrist 4 months ago and still have many questions...I am doing it part-time, so it has been challenging to fit in bringing myself up to speed on all of the rules. One thing I still don't know is how to bill if a patient is in a SNF/Skilled Nursing Facility and brought into the office for footcare. I live in Northern California...I have researched, but am still not confident about my podiatry billing skills. I have been a biller/coder for 10 years now, but Podiatry has definitely been a challenge. Would you be willing to allow me to email a few questions as they come up? And are you able to answer my SNF question?  Thank you for taking time to look at my question. My email is green_dm@hotmail.com


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## sandrastallone (May 29, 2015)

*Billing Specialist/Coder*

Hello Tammy
in a few weeks I will be doing some billing for a Podiatry office out of south carolina and one out of California, I am looking for any leads to areas where I can research and find more rules for podiatry.  thank you in advance for any direction


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