Podiatry Coding & Billing Alert

Question: We have a new podiatrist on board and he performs corn removal and nail debridement for diabetic Medicare patients regularly. Am I supposed to use the Q7, Q8, and Q9 modifiers with the the CPT^® codes? I am having trouble finding clarification of the description of these codes and when appropriate to use them.

Alabama Subscriber

Answer: Your scenario will most likely count as routine foot care and the LCD states that routine foot care can only be provider once every 60 days. Some offices schedule the service every 10 weeks to simplify the process.

According to HCPCS Level II manual, one of the modifiers Q7, Q8, or Q9 must be reported with codes 11055 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; single lesion), 11056 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; 2 to 4 lesions), 11057 (Paring or cutting of benign hyperkeratotic lesion [e.g., corn or callus]; more than 4 lesions), 11719 (Trimming of nondystrophic nails, any number), and G0127 (Trimming of dystrophic nails, any number), and with codes 11720 (Debridement of nail[s] by any method[s]; 1 to 5) and 11721 (Debridement of nail[s] by any method[s]; 6 or more) when the coverage is based on the presence of a qualifying systemic condition (such as diabetes), to indicate the class findings and site:

Q7 - One (1) Class A finding
Q8 - Two (2) Class B findings
Q9 - One (1) Class B finding and Two (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)

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.”