“My practice involves a lot of routine foot care and I am looking for clarification. In using Q8 and Q9 modifiers, do you need to have atherosclerotic peripheral vascular disease (ASPVD) as a diagnosis? If so what’s the code to be used for general ASPVD? Modifier Q7 indicates that there has been an amputation. It is not necessary to have an ASPVD diagnosis in that scenario?”
Whenever the Q7, Q8, and Q9 modifiers are brought up, the topic automatically is about “At Risk,” Routine Foot Care. Atherosclerotic peripheral vascular disease (ASPVD) is not the only systemic disease set that qualifies a patient for this service. With only a few exceptions, most Medicare Administrative Carriers have an LCD with an associated article regarding billing and coding for “Routine Foot Care.” For those Medicare Administrative Carriers that do not have this LCD, there are two options. You can access the LCD for Routine Foot Care of another Medicare Administrative Carrier since they do share information, or you can access the Medicare Benefits Policy Manual, Chapter 15, Section 290, Foot Care.
When you access the LCD, you are provided with a rather long list of systemic diseases that qualify the patient for “At Risk,” Routine Foot Care. It is evident that this list goes beyond atherosclerotic PVD. Now, if you want to use the ICD-10-CM code for “general ASPVD,” the most appropriate code is I73.9 defined as: Peripheral vascular disease, unspecified. Please be aware, that one Medicare Administrative Carrier, Noridian Administrative Services, LLC no longer accepts I73.9 as a covered ICD-10-CM code for “At Risk,” Routine Foot Care due to the lack of specificity.
With respect to the Q7 modifier, it is defined as: non-traumatic amputation of the foot or an integral skeletal part of the foot. More likely than not, a non-traumatic amputation is the result of a vascular complication. However, the ICD-10-CM code that is tied to the Q7 modifier does not necessarily need to be linked to atherosclerotic PVD. Any covered systemic disease that results in a vascular complication that leads to a non-traumatic amputation of the foot or integral part of the foot would be appropriate. Vascular complications of diabetes are at the top of the list.
This is my opinion,
Michael G. Warshaw
DPM, CPC
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