Wiki Regarding Q modifier and podiatry

[01503628]

Hi All,

Somebody please help me!!!

LCD article # A57954 if group 3 codes such as E11.51 , E11.52 are billed without Q modifier claims getting denied for 11721/11720/11719.
Is there any guidelines to follow.
Your answers are most welcome!

Thank in advance!

 

[bgrasson]

Modifiers Q7, Q8, and Q9 are to be used to bill podiatric services.

Modifier	Description
Q7	One Class A Finding
Q8	Two Class B Findings
Q9	One Class B and Two Class C Findings

Class Findings​

Class A:
Non-traumatic amputation of foot or integral skeletal portion thereof
Class B:
Absent posterior tibial pulse
Absent dorsalis pedis pulse
Advanced trophic changes (at least three of the following):
Decrease or absence of hair growth
Nail thickening
Skin discoloration
Thin and shiny skin texture
Rubor or redness of skin
Class C:
Claudication
Temperature changes (cold feet)
Edema
Paresthesia (abnormal spontaneous sensations in feet)
Burning

 

[podcoder70]

I want to make sure I understand your question...
You are billing 117XX cpt codes with group 3 icd10 codes without a Q modifier? The group 3 icd10 codes represent those diagnoses where the patient has evidence of vascular impairment, for which the class findings modifiers are required. So, without the Q modifier you will get denied. The podiatrist must document either 1 class A, or 2 class B, or 1 B and 2 C class findings to be able to add the Q modifier to the claim. Without the documentation, the Q modifier cannot be added and without it, the claim will not get paid.

If your question was instead, that you ARE adding the Q modifier and still getting denied...it's likely because you are using an icd10 code in group 2 or 3 with an asterisk, which means you have to add the name and npi of the primary care doctor that is treating the condition and the approximate date the patient saw that doctor.

Also, the link for the LCD you referenced goes to one that has been replaced. I attached the current one.