Modifier for 11720

[oh207]

Is it necessary to use a modifier with 11720 and 11721 for Medicare?

 

[jdrueppel]

My local Medicare carrier has a LCD regarding these codes. Dependent on the diagnosis it may be necesary to add the Q7, Q8 or Q9 modifier. If you are having payment issues check your local carriers LCD. This is not my specialty and, of course, you would not be billing both of these codes on the same patient at same setting.

Julie, CPC

 

[belindapearl]

I am in the J Mac 5 jursidictation and all we need is the diagnosis 110.1 for onychomycosis. Make sure your documenation fits for this diagnosis they do check at least once a year. In the past we not only had to have the Q modifiers they also required the doctor treating the diabetes and the date that was last seen.

 

[oh207]

We are in the J13 jurisdiction National Government Services, and the LCD states that the 110.1 must be submitted with a secondary diagnosis eg, pain in limb or abnormality of gait. The Q modifiers we would use if the patient had diabetes also, but do you know if they require the T modifiers if the patient does not have diabetes but has one of the additional diagnoses? Thanks for your reply.

 

[belindapearl]

The T modifiers are to indentfy only one toe, I do not think this would be needed since the code states 11720 1-5 and 11721 six or more.