Wiki Foot Care LCD Group code

[chessieloewen]

Hello, I have a question about the foot care LCD for Ohio. Some of the ICD codes are listed in group 1 and group 4, for example e11.41. So how do I know when I need to use a Q modifier for these diagnoses?

This is the LCD : https://www.cms.gov/medicare-covera...de=11721&hcpcsEndCode=11721&sortBy=title&bc=1

 

[podcoder70]

This is the article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57193&ver=21&=
The articles list the diagnosis codes and the LCD often times gives more info regarding coverage.

Here is the LCD: https://www.cms.gov/medicare-covera...228*2&Cntrctr=228&DocType=2&bc=AAACAAIAIAAA&=

The LCD states the following: Note: Benefits for routine foot care are also available for patients with peripheral neuropathy involving the feet, but without the vascular impairment outlined in Class B findings. The neuropathy should be of such severity that care by a non-professional person would put the patient at risk. 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 appropriate ICD-10-CM code being included on the claim.

Group 1 diagnosis codes include those with asterisks that require the name/npi of the doctor treating the systemic condition and the approximate date last seen. These may or may not require the class findings. In general, those that require the Q modifier/class findings are related to circulation and start with an I for non diabetics or have a 5 in the 4th digit for diabetes codes. The codes in group 4 are those that DO NOT require class finding/Q modifier.

diagnosis codes, diagnosis coding