Good Afternoon!
Per Medicare LCD Reference Article A57759:
I know it says "in the absence of a systemic condition" but I wanted to double check in case there's an alternative that I just don't know about:
If the patient has a systemic condition but they don't have enough to meet a class C finding Q modifier, can we take the second guidelines of secondary symptoms (i.e. pain) into consideration and still bill for the 11721?
For example, Patient with DM, B35.1 with pain, a DM managing provider, and a date last seen within the last 6 months, with 2 class C findings BUT only 2 out of the 3 Advanced trophic changes, pulses are fine - we won't be able to add the Q9 modifier to 11721 but can we use the B35.1 and pain code to still bill for the 11721 without a Q mod even though the patient is diabetic?
Thank you!
Per Medicare LCD Reference Article A57759:
I know it says "in the absence of a systemic condition" but I wanted to double check in case there's an alternative that I just don't know about:
If the patient has a systemic condition but they don't have enough to meet a class C finding Q modifier, can we take the second guidelines of secondary symptoms (i.e. pain) into consideration and still bill for the 11721?
For example, Patient with DM, B35.1 with pain, a DM managing provider, and a date last seen within the last 6 months, with 2 class C findings BUT only 2 out of the 3 Advanced trophic changes, pulses are fine - we won't be able to add the Q9 modifier to 11721 but can we use the B35.1 and pain code to still bill for the 11721 without a Q mod even though the patient is diabetic?
Thank you!