“We are inquiring about the use of the Q7 modifier when billing nail and callus debridement with Medicare. We are aware of the changes to the LCD with diagnosis codes. When billing nail debridement CPT 11721 and callus debridement CPT 11056, we are submitting diagnosis codes Z89.412 and Z89.422, (acquired absence of toe) with a Q7 modifier to show “non-traumatic amputation of a foot or an integral skeletal part of the foot.” Now we are being told by Medicare that per the LCD, we cannot bill those diagnosis codes even with a Q7 modifier. Should we be billing with a different modifier?”
When it comes to medical coding and billing, the most important question that needs to be asked is “why?” In the above post that references the appropriate use of the Q7 modifier, it appears that the ICD-10-CM codes that are linked to CPT code 11721 (Debridement of nail(s) by any method(s); 6 or more) and CPT 11056 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions), Z89.412Acquired absence of left great toe) and Z89.422 (Acquired absence of other left toe(s) are not appropriate to achieve reimbursement for both CPT codes. I ask the question WHY? Well, Z codes represent reasons for encounters. They are not diagnoses that qualify CPT/procedure codes for reimbursement.
When the Q7 modifier is appended to a CPT code, it should be apparent that the situation at hand is “At Risk,” Routine Foot Care. The Q7 modifier is one of the Q modifiers (Q7, Q8, Q9) that must be appended to the CPT or HCPCS Level II code ( CPT 11055, CPT 11056, CPT 11057, CPT 11720, CPT 11721, CPT 11719, G0127) that represent the Class Findings that the patient demonstrates on physical examination. There are three varieties of Class Findings. They are Class A, Class B and Class C. As far as the Q7 modifier is concerned, Class A Finding: Use –Q7 on claim form if there is a Class A finding. There is only 1 Class A Finding: Non-traumatic amputation of a foot or an integral skeletal part of the foot. ICD-10-CM codes Z89.412 and Z89.422 essentially state that there is an acquired absence of a toe or toes on the left foot, but again in order to achieve reimbursement, the question once again is WHY is there an acquired absence of toes on the left foot?
This comes down to linking or associating the appropriate, covered systemic illness that the patient is being treated for by his/her MD/DO that lead to the “Non-traumatic amputation of a foot or an integral skeletal part of the foot.” This is the ICD-10-CM code that needs to be the primary diagnosis that is linked to both CPT codes 11721 and 11056.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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