Podiatry Coding & Billing Alert

Question: I am billing 11721 with the primary diagnosis 110.1 (Dermatophytosis of nail), and other diagnoses 250.60 (Diabetes mellitus), and 443.9 (Peripheral vascular disease, unspecified). I'm curious why Medicare would require a Q modifier?

Mississippi Subscriber

Answer: Medicare requires a Q modifier to determine the extent and  nature of the patient's health status. If the service involves nail care, then you should append a Q modifier. If it does not qualify then it is probably a cash patient and not necessarily a qualified E/M visit.

Red flag: If the sole purpose of the visit is to trim or debride nails or calluses, then you should never bill both a visit code and 11721 (Debridement of nail(s) by any method(s); 6 or more). Only when you have a separate identifiable diagnosis can you charge for an E/M visit.

Examples of Q modifiers include Q7 (One Class A finding), for example non-traumatic amputation of foot or integral skeletal portion thereof; Q8 (Two Class B findings), for example absent pulses; and Q9 (One Class B finding and two Class C findings), for example softer vascular or neurologic signs.