Difference between an Asterisk and a Non-Asterisk Systemic Disease with Respect to "At Risk," Routine Foot Care

What is the difference between an asterisk and a non-asterisk systemic disease with respect to “At Risk,” Routine Foot Care?

What is an Asterisk Systemic Disease?  Medicare has published a list of Systemic Diseases that can cause severe circulatory embarrassment or areas of desensitization in a patient’s leg or foot. Medicare has designated several of these diseases with an “asterisk” (*) to denote that patients with one of these diseases must be under the active care of an MD or DO. Active care means that the MD or DO is treating the patient for that disease and has been seen at least once in the past 6 months for that disease prior to the foot care encounter. This is referred to as the Active Care Requirement.

An “Asterisk” systemic disease simply refers to a disease that Medicare designates the necessity for an MD or DO physician to actively treat the patient for that qualifying systemic disease. Actively means that the patient has to have been seen by the MD or DO within a 6-month period for that specific disease. This is referred to as the “Active Care Requirement.” When a Podiatrist provides a routine foot care service (11055, 11056, 11057, 11719, 11720, 11721 or G0127) to a patient with an “asterisk” systemic disease they can bill and be paid by Medicare, but must include specific information in their medical record:

Please confirm the following with your Medicare Administrative Carrier’s LCD and associated article on billing and coding for Routine Foot Care

1. 1. The treating MD or DO’s name of the qualifying systemic disease/ICD-10-CM code
2. 2. The date last seen by the MD or DO
3. 2. The systemic disease and associated complication(s) resulting from the disease (These are the Class Findings that lead you to select the appropriate Q modifier)

What is a non-asterisk systemic disease? A systemic disease that does not have a Medicare asterisk designation has different requirements for record keeping and billing. The systemic disease diagnosis and subsequent treatment of that systemic disease can be made by an MD or DO as appropriate. In actuality, the qualifying systemic disease diagnosis/ICD-10-CM code can also be made by the treating podiatrist based upon the lower extremity vascular examination and the patient’s history. It is necessary to have adequate medical record documentation to support the diagnosis making decision…and subsequent treatment. The simple indication of a systemic diagnosis without documentation is not adequate. Please note that since DPM’s are limited scope practitioners, a DPM cannot treat a systemic disease. A DPM can treat the manifestations, complications, or end results of a systemic disease when they appear in the treating area of a DPM, the foot and the ankle. The date last seen is not a requirement for the non-asterisk systemic diseases.

Specific information must be present in the medical record. Please confirm the following with your Medicare Administrative Carrier’s LCD and associated article on billing and coding for Routine Foot Care.

1. 1. The treating MD or DO’s name of the qualifying systemic disease/ICD-10-CM code
2. 2. The systemic disease and associated complication(s) resulting from the disease (These are the Class Findings that lead you to select the appropriate Q modifier)

This is my opinion.

Michael G. Warshaw

DPM, CPC

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