Is Medicare denying your claims for all routine foot care services? Modifier Q8 can help you avoid this problem in certain situations! One common fact about Medicare is that it excludes routine services from its coverage. Hence, countless practices regularly lose a lot of money. How many times have you experienced the same thing as a podiatrist?
Podiatry already has higher denial rates than many other specialties. So, the situation is already quite concerning. That’s why you should be fully prepared to tackle complicated problems, including billing for medically necessary routine foot care services. Read on to understand how to do this with the Q8 modifier.
Modifier Q8 Description
So, what additional information does modifier Q8 provide? Introduced by the Centers for Medicare & Medicaid Services (CMS), this HCPCS modifier reports two class B findings. But what does this actually mean? Let us explain this vague description in detail!
Modifier Q8, in simple terms, indicates that a patient has a systemic condition, such as diabetes, that affects their foot health. To be more specific, it specifies that the routine foot care service performed by a professional is medically necessary to avoid the risk of infection or injury.
So, if you performed a routine foot care service for a patient with any of the following two conditions, you can use this modifier to request reimbursement.
Class B Findings
- Absence of a posterior tibial (a branch of the popliteal artery located behind the medial malleolus) pulse
- Absence of a dorsalis pedis (a major oxygen-carrying artery located at the top of the foot) pulse
- Advanced trophic changes (abnormalities), at least three of the following:
- Thickening of a nail
- Changes in skin texture (thin and shiny)
- Skin discoloration
- Rubor or redness of skin (signs of inflammation)
- Decrease or absence of growth (hair loss)
When to Use Modifier Q8?
Confused about when to use the Q8 modifier? Here are three specific examples:
Trimming a Diabetic Patient’s Nails with Class B Findings
Did you know that diabetic patients are at a higher risk of developing foot conditions, including peripheral neuropathy? This can lead to serious complications, including unnoticed wounds and even amputation in severe cases. Therefore, only professionals should provide appropriate treatment for these patients’ foot problems.
So, for the first scenario, suppose a 34-year-old man with type 2 diabetes experiences increased tingling and numbness in his left foot. Due to poor blood circulation, he cannot trim his nails on his own. Therefore, he arrives at a podiatry clinic to avoid improper trimming and infection.
Before rendering the service, the healthcare provider examines the patient’s left foot and notices two things: the absence of a dorsalis pedis pulse and three trophic changes, including less hair on the left foot compared to the right one. The provider trims the patient’s toenails and uses modifier Q8 with CPT code 11719.
Corn Removal with Class B Findings
Did you know that atherosclerosis (hardening of the arteries) also impacts a patient’s legs and feet? This systemic condition is often the underlying cause of peripheral artery disease, which leads to foot infections and inflammation.
So, for the second example, consider a 47-year-old man with a corn on his right foot. Upon his arrival, the podiatrist takes his history and discovers that he has a systemic condition, atherosclerosis. Suspecting that the patient may also have peripheral artery disease, the podiatrist examines him thoroughly before providing the service.
He notices the absence of the dorsalis pedis pulse, along with redness of the skin, thin, shiny skin, and discoloration. The podiatrist then uses a scalpel to remove the corn and applies modifier Q8 to the appropriate code (11055) to bill for the procedure.
Nail Debridement with Class B Findings
Around 7 million people in the U.S. have psoriasis. Among them, up to 55% of patients have nail diseases. So, for our final example of modifier Q8, let’s consider a 19-year-old man with nail psoriasis. He arrives at a podiatry clinic for nail debridement (up to two nails).
The main reasons for this procedure? To reduce the pain and discomfort caused by thickened nails. The patient informs the podiatrist about his systemic condition before the procedure. The podiatrist examines the impacted toenails and notices discoloration and changes in skin texture (thin skin).
He then removes the nails and appends modifier Q8 to CPT code 11720 when filing the claim.
Accurate Usage Guidelines for Modifier Q8
So, what are the rules for using the Q8 modifier? Let’s look at the accurate and inaccurate uses of this code:
Accurate Uses of Modifier Q8
Don’t make the mistake of using this modifier to bill for all routine foot care services. Modifier Q8 is only applicable in two conditions:
- If the routine foot care is medically necessary and is a crucial part of otherwise covered services (for example, diagnosing and treating ulcers, wounds, or infections)
- If the patient has a systemic condition (metabolic, neurologic, or peripheral vascular disease)
If you are confused about the covered systemic conditions, don’t worry. Medicare highlights them in its Benefit Policy Manual.
Inaccurate Uses of Modifier Q8
Modifier Q8 is inapplicable if:
- The patient has no systemic condition
- There are no Class B findings
- The patient performs the routine foot care services, such as nail trimming, cutting or removing corns, at home.
- There is a Class A finding, or one Class B and two Class C findings.
Other Important Billing Requirements
Are you now familiar with the accurate and inaccurate uses of this modifier? Follow these tips as well to avoid denials:
- Append modifier Q8 directly to routine foot care service codes (for example, 11055-11057, 11719-11721, G0127)
- Document the two Class B findings and the patient’s systemic condition.
Summary
Is your podiatry practice using the correct class finding modifier for routine services? Many podiatrists and their billing teams misuse the Q8 modifier, confusing it with Q7 or Q9. This leads to costly denials and dissatisfied patients. Although we have covered this HCPCS modifier quite comprehensively, let us summarize the key details.
Modifier Q8 highlights two Class B findings, such as absent posterior tibial pulse and trophic changes. You can directly apply this modifier to a routine foot care service code if you notice these signs in a patient with a systemic condition, like diabetes or peripheral artery disease.
We don’t want you to face payment delays and denials due to the incorrect usage of this modifier. Therefore, we have provided three specific examples of when to use modifier Q8 along with accurate usage guidelines. Follow our instructions to bill Medicare accurately for medically necessary foot care services!
