Medicare through the Medicare Benefits Policy Manual and the Medicare Administrative Carriers through their LCDs for Routine Foot Care have 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 make the diagnosis and actively treat the patient for that disease. Actively means that the patient must 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 and on the billing claim form.
Include the following in your medical record: Please confirm with your Medicare Administrative Carrier’s LCD for Routine Foot Care.
The treating MD or DO’s name
The date last seen by the MD or DO (Day, Month, Year)
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 to append to the CPT/HCPCS Level II codes that you bill).
Include the following on the billing claim form or the electronic equivalent: Please confirm with your Medicare Administrative Carrier’s LCD for Routine Foot Care.
The name of the MD or DO treating the systemic disease in Field 19 of the CMS-1500 form
The NPI of the MD or DO treating the systemic disease in Field 19 of the CMS-1500 form
The date last seen by the MD or DO in Field 19 of the CMS-1500 form (Day, Month, Year)
*The systemic disease (ICD-10 code) of the treating MD or DO in Field 21, line 1 (Primary Diagnosis)
*DPM’s Podiatric Diagnosis (ICD-10 code) in Field 21, line 2 (Secondary Diagnosis)
Use either 11055, 11056, 11057, 11719, 11720, 11721, or G0127 in Field 24d as performed. Append with the appropriate Q modifier in Field 24d (Q7, Q8, Q9)
This is my opinion.
Michael G. Warshaw
DPM, CPC
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