Medical billing requires precision and accuracy. To ensure this precision, insurance payers like Medicare ask billers to append the appropriate modifiers to the appropriate procedural code on the same claim line. One frequently used modifier in podiatry practices is the modifier Q9. Despite its frequent use, many billers face denials. The reason? Ignoring payer guidelines!
So, what is the correct way of appending the Q9 modifier? You will find out in this guide. Our expert billers at MediBillMD have explained everything in detail, including what this modifier means and when to apply it. So, let’s start.
Modifier Q9 – Description
“One Class B and two Class C findings”
The Q9 modifier is specifically for podiatry procedures. It indicates that a patient has one Class B finding and two Class C findings during the foot evaluation. These Class findings are documented during the physical evaluation and not during the service provision. The whole purpose of this modifier is to determine whether routine foot care procedures, such as nail debridement or callus removal, are medically necessary.
The use of the Q9 modifier ensures that claims align with Medicare’s coverage criteria
for routine foot care, which is typically not covered unless specific medical conditions are
present.
But what exactly are Class B and Class C findings? Well, to understand the usage of Q9, it is essential that we first understand these classes.
The B and C classifications are used to evaluate the extent and severity of a patient’s systemic condition. Usually, this involves the examination for peripheral vascular disease, metabolic disease, or any neurological issues that might affect the feet.
| Class | Findings |
|---|---|
| A | Non-traumatic amputation of the foot or integral skeletal portion thereof |
| B | Absent posterior tibial pulse |
| Absent dorsalis pedis pulse | |
| Advanced trophic changes (at least three of the following): • Skin discoloration • Thin and shiny skin texture • Rubor or redness of the skin • Nail thickening • Decrease or absence of hair growth | |
| C | Claudication (pain in legs during walking) |
| Temperature changes in the foot (cold feet) | |
| Edema (swelling) | |
| Paresthesias (tingling or numbness) | |
| Burning sensation in the foot |
When to Use Modifier Q9?
The modifier Q9 is only used with specific routine foot care procedures. So, it must always be accompanied by the appropriate CPT and HCPCS codes related to routine foot care. According to Medicare’s routine foot care billing and coding guidelines, the following procedural codes are valid for Q9:
- 11055: Paring or cutting (removal) of a single benign hyperkeratotic lesion (e.g., corn or callus.
- 11056: Paring or cutting (removal) of two to four benign hyperkeratotic lesions.
- 11057: Paring or cutting (removal) of more than four benign hyperkeratotic lesions.
- 11719: Trimming of non-dystrophic nails, any number
- 11720: Debridement of nail(s) by any method(s); one to five
- 11721: Debridement of nail(s) by any method(s); six or more
- G0127: Trimming of dystrophic nails, any number
Usually, the Q9 modifier is used for Medicare claims. However, other insurers may have different requirements, so providers should verify payer-specific guidelines before submitting claims with this modifier.
Let’s simplify all of this with an example.
Suppose a patient visits a podiatrist. He is suffering from peripheral artery disease. The physician carefully examines the feet and notices that the patient’s posterior tibial pulse is absent (Class B), and he is experiencing claudication and edema (Class C).
The physician performs nail debridement (CPT code 11721) on the affected feet. However, to prove the procedure’s medical necessity, he must report one Class B and two Class C findings and bill the claim with the Q9 modifier.
Accurate Usage Guidelines for Modifier Q9
The following guidelines will help you improve the chances of claim acceptance on the first try.
Provide the Necessary Documentation
Documentation is essential to justify the need for Q9. Physical examination findings must be specific and measurable. Rather than general statements like ”patient has poor circulation,” documentation should specify ”absent posterior tibial pulse on bilateral examination” or ”patient reports claudication after walking two blocks, requiring rest periods.”
Avoid Misuse of Modifier Q9
Misusing the modifier will not only lead to claim denials but trigger audits as well. Do not use this modifier if the patient does not meet the exact criteria (one Class B and two Class C findings). If the patient meets other class criteria, you can use modifier Q7 or Q8 instead.
Other Billing Tips for Modifier Q9
Finally, follow these two additional tips to receive timely payments:
- Apply this modifier directly to the appropriate CPT or HCPCS code (for example, 11057-Q9).
- Submit complete documentation, including the class findings, method used for lesion removal or nail debridement/trimming, and treatment results.
Final Word
We hope you now understand the accurate use of modifier Q9. Here’s a quick recap in case you missed anything. Q9 is a podiatry modifier and should be used if the physician discovers one Class B and two Class C findings during physical examination.
We tried to cover every detail of this two-digit code so you can understand its correct application and avoid denials. If you are still confused, consider getting coding assistance from professionals at MediBillMD. They offer some of the best podiatry billing services in town.
