Wiki WPS LCD for Routine Foot Care (L26642)

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missyah20

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I am a little confused with the wording in part of this LCD and I am hoping that someone can clarify it for me.

Under the section "ICD-9 Codes that Support Medical Necessity" the first paragraph states:
"*When billing CPT codes G0127, 11055, 11056, 11057, 11719 the Q modifier always must be used to indicate that there are systemic conditions that will allow the service to be covered. When billing CPT codes 11720 or 11721 the Q modifier must always be used with ICD-9 codes in list one and list two."

Does this mean that the first set of CPT codes mentioned always need a Q mod and a systemic condition to be pd or are they payable with one of the first 4 dx codes listed (1101, 700, 7038, and 7039(these dx codes are not part of list1,2, or 3 in the LCD)) w/o a Q mod?

Thanks in advance for the help!
 
missyah20 said:
I am a little confused with the wording in part of this LCD and I am hoping that someone can clarify it for me.

Under the section "ICD-9 Codes that Support Medical Necessity" the first paragraph states:
"*When billing CPT codes G0127, 11055, 11056, 11057, 11719 the Q modifier always must be used to indicate that there are systemic conditions that will allow the service to be covered. When billing CPT codes 11720 or 11721 the Q modifier must always be used with ICD-9 codes in list one and list two."

Does this mean that the first set of CPT codes mentioned always need a Q mod and a systemic condition to be pd or are they payable with one of the first 4 dx codes listed (1101, 700, 7038, and 7039(these dx codes are not part of list1,2, or 3 in the LCD)) w/o a Q mod?

Thanks in advance for the help!
Click to expand...

Missy,

This refers to the fact that the nail debridements can be performed for patients that qualify for covered Routine Foot Care via a systemic condition OR symptomatic problems that are currently presenting for a patient. The extra DXs indicate symptomatic complications for the patient - but, they would not be at-risk and therefore would not need or qualify for the Q modifiers.
 
Wps lcd l26642

To qualify for routine foot care the first dx code you would use would be from the first four dx codes listed. The patient must also have Q findings and one of the listed systemic problems.
Unless the patient has a non-traumatic amputation of a foot or part of a foot (toe) (Q7) the patient must have both a Q finding and a systemic condition.

The only other time routine foot care is covered (for nails) is if the patient is being treated for Mycotic nails and then there are other guidelines that have to be met.

Hope this helps.
 
I have made this little cheat sheet to use for Q modifiers and refer to it often:

Q7 - 1 Class A Findings
Q8 - 2 Class B Findings
Q9 - 1 Class B Findings and 2 Class C Findings

Class A Findings
* Non-traumatic amputation of foot or integral skeletal thereof

Class B Findings
* Absent posterior tibial pulse
* Absent dorsalispedis pulse
* Advance trophic changes such as (3 required)
- Hair growht decreased
- Nail changes
- Pigmentary changes (discoloration)
- Skin texture (thick, shinny)
- Skin color (ruber or redness)

Class C Findings
* Claudication
* Temperature (e.g. cold feet)
* Edma
* Parethesias (abnormal spontatneous sensations in feet)
* Burning
 
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