routine foot care

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I am new to podiatry coding and trying to make sense of all this. Here's my scenario. The dr performed an exam on a new patient who is diabetic. The patient has elongated nails, edema and no pain (according to the note this patient is confined to a wheelchair) Per the exam the dr found the feet and toes to be normal bilaterlly with no hypertrophy, discoloration, ingrowing,subungal debris and tenderness. All of the toenails were elongated and debridement was performed on all 10 toenails.
Furthermore, debridement was performed on 2 hyperkeratotic areas.

Should i bill 11056 with 700, 250.00, 782.3 and 11721 with 250.00 and 782.3

Where does the Q modifiers come into play?

Any and all explanations are greatly appreciated!
 

tammster

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Hi Denise,

What state are you in? Surprisingly, that can make a difference in the linkage requirements as well as the Q modifier need.
 
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tammster

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It looks like your state requires the Q modifier for all 'qualified' Routine Foot Care...in order to show the extent of the 'risk' for your at-risk patients.
 

tammster

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Also, I would recommend billing the 11056 with the systemic condition as the primary diagnosis (250.00) as well as the 11721.
 

kslynn

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Q modifiers

Along this same line, I am coding for a Podiatrist who has seen a pt that meets the criteria for both the class Q7 and Q9. Which one should I use, should I use both or does it matter?
 

tammster

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Once a patient is Q7, since it's the more severe, it should be the Q modifier used.

It further indicates medical necessity, without a doubt, because of the severity of the complications with their systemic condition.
 

annamaria1827

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I work in podiatry for third year. Requirement of Medicare to routine foot care is change every year, and became very narrowing. In 2014 Medicare no more accept diabeted w/out complication as medical necessary DX. If clinic wants to get reimbursement, must be all billing according to LCD26426.
According to this LCD:
11720-11721. Must be billed first 110.1 or 703.8, second DX can be 729.5/ 681.10/ 684.11/703.0/ 719.7/ 781.2/ systemic Dx from list of DXs in this LCD. Here the slesh is means "or". DLS must be recorded if systemic Dx from list of LCD's DXs with asterics.
11055-11057. It is critical, must be applied Mod Q to get reimbursement. If pt has condtion to apply Mod Q and systemic DX from list of LCD- claim will be reimbursed.
If patient has condition to apply Mod Q and has no systemic DX, but has 110.1, you can use 110.1 as first and it would be medical necessary DX.

Hope it will help!
Best wishes!
 
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