MarciaH
Guest
Billing a 11721 px with a dx of 1101 and 44020. Getting denied. Is it because of not using a Q modifier? Anyone have this prob?
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Wiki 11721?
- Thread starter MarciaH
- Start date
MarciaH
Guest
Oh and it's Medicare that is denying.
mitchellde
True Blue
I believe if you probe a little further you may find that only a dx of diabetes will get this paid with Medicare, I know that used to be the case but I have have not stayed on top of this one recently. What did the denial state as the reason.
There are two ways to get Medicare to pay the 11721 code. You will need to check the policies of your particular carrier.
The first way is to use the ICD-9 codes of 110.1 and 729.5. You would, of course, want to make sure both of those dxs apply in your particular patient's situation and both dxs would need to be documented.
The other way is to use a systemic diagnosis (like diabetes) as the primary diagnosis. Then you need to use one of the "Q modifiers" depending on which would apply for a particular patient. You must also contact the primary care physician that is treating the systemic disease to find out the last time the patient saw the primary care physician in the last six months and this all must be entered in the correct boxes of the insurance claim form.
Hope this is helpful.
The first way is to use the ICD-9 codes of 110.1 and 729.5. You would, of course, want to make sure both of those dxs apply in your particular patient's situation and both dxs would need to be documented.
The other way is to use a systemic diagnosis (like diabetes) as the primary diagnosis. Then you need to use one of the "Q modifiers" depending on which would apply for a particular patient. You must also contact the primary care physician that is treating the systemic disease to find out the last time the patient saw the primary care physician in the last six months and this all must be entered in the correct boxes of the insurance claim form.
Hope this is helpful.
Even if the patient is a diabetic Medicare is requiring the Q modifiers on almost all nail and callus debridements. Diabetes is no longer an automatic payment diagnosis. Here is a short run down for the Q modifier. Always double check you local LCD policy:
I have made this little cheat sheet to use for Q modifiers and refer to it often:
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 (ruber or redness)
Class C Findings
* Claudication
* Temperature (e.g. cold feet)
* Edema
* Parethesias (abnormal spontaneous sensations in feet)
* Burning
I have made this little cheat sheet to use for Q modifiers and refer to it often:
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 (ruber or redness)
Class C Findings
* Claudication
* Temperature (e.g. cold feet)
* Edema
* Parethesias (abnormal spontaneous sensations in feet)
* Burning
MarciaH
Guest
When using the Q modifier, do you always need PCP name and visit everytime?
No only if your diagnosis that requires the PCP information such as diabetes but a diagnosis of peripheral vascular disease does not. Review your LCD to find out which diagnosis requires the PCP information.