Wiki Q8 modifier and tibial pulses

[rmness]

Is it appropriate to use the Q8 modifier if the provider documents "posterior tibial pulses were absent bilaterally" with no other class findings? The provider states there isn't anything that says you can't count them twice as technically it is two seperate items (1 from each leg) and that should fulfill the two items needed from the class B findings.

 

[hofm04]

see Medicare Beneift Policy Manual Chapter 15; SS 290.
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

For Q8 you need two of the criteria from class B.

 

[hofm04]

I misread your question. That is a good question. I do not know but I submitted it to CMS.

 

[rmness]

Please let me know how they respond, it is a good point they are making. Thanks!!

 

[Randi]

clarification of Q8 modifier

I am just wondering if a consensus was ever reached? My Providers will use either posterior tibial or dosalis pedis pulse absent bilateral regularly. I really feel this supports the intent of the Class Findings. But would really like to hear how others view this. Thanks

 

[tammster]

From Noridian Q&A to a podiatry webinar, held this past August:

Q7. When determining Class B findings, how should providers count Dorsalis Pedis (DP) pulses?
A7. When treating both feet, the DP pulse is counted as one for each foot.

The full list of questions can be accessed here - https://med.noridianmedicare.com/web/jeb/education/event-materials/podiatry-qa

 

[rmness]

Thanks so much Ursala! Noridian is a great resource.

 

[bostonmom]

Does anyone know if the pulses are detected by doppler only, if that can count as absent? Trying to get a handle on the absent part.
Pulses:
Dorsalis pedis pulses are detected w/ Doppler on the right side and detected w/ Doppler on the left side.
Posterior tibial pulses are detected w/ Doppler on the right side and detected w/ Doppler on the left side.

Any guidance will be greatly appreciated!

 

[MPopkin]

@bostonmom did anyone answer you - I am auditing providers that always do this- I wish they would just state they are absent