Wiki Need help with LCA A57188

[jkottarathil]

Hello,

Can someone please help me to better understand LCA A57188 - Routine Foot Care for Florida? I'm not fully understanding what the 4 different categories are for diagnosis codes and how to apply them.

Group 1 - CPT/HCPCS codes: 11055-11057, 11719-11721, G0127.
Group 2 - CPT/HCPCS codes: 11055-11057, 11719-11721, G0127 only with modifier Q7, Q8, or Q9.
Group 3 - CPT/HCPCS codes: 11055-11057, 11719-11721, G0127 with peripheral neuropathy
Group 4 - CPT/HCPCS codes: 11055-11057, 11719-11721 for anticoagulation therapy

What is group 1 for? Is it for if a patient doesn't meet any of the other requirements for another group?

Group 3 says that it's for CPT/HCPCS codes: 11055-11057, 11719-117121, and G0127 for peripheral neuropathy and then it gives a list of codes. Does this mean that the patient must have peripheral neuropathy documented along with one of these codes?

Similar for group 4, is it only used when the patient is on anticoagulation therapy?

diagnosis codes, diagnosis coding

 

[podcoder70]

Hey there! I understand the frustration. I have been coding Podiatry for over 20 years and I always tell those that are new to Podiatry to not get frustrated, it is one of the most complicated code sets out there and the CMS rules add to that.

The groups for Florida LCD on Routine Foot Care is an attempt to simplify the LCD by dividing the codes by diagnosis type, that's all. Group 1 are those diagnosis codes that "cover" calluses and nails. Group 2 are the diagnosis codes that require a Q modifier. Group 3 are peripheral neuropathy codes. Group 4 are codes for anticoagulation therapy.

The primary thing to look for when billing 11055-7 and 1170-1 is to add Q modifiers where necessary and include the primary care doctor and approximate date last seen for those diagnosis codes with an asterisk.

I hope this helps!!

diagnosis codes, diagnosis coding