27 Sept 2016

MODIFIER Q7, Q8 and Q9

MODIFIER Q7, Q8 and Q9 These modifiers are used in podiatry claims.  


Podiatry findings used to determine routine foot care


        Patients who have systemic conditions might have metabolic, neurological, or peripheral vascular disease results in decreased sensation or severe circulatory problems like absent pulses in the foot, skin changes due to arterial insufficiency, or claudication in the patient's feet.


        When a complicating systemic condition is present, the patient must have Class A, B or C findings. It must be documented in the medical record to append appropriate modifier with podiatry CPT codes.


A.   Class A finding (Use Q7 Modifier) one point required


    1. Non-traumatic amputation of the foot or integral skeletal portion thereof


B.   Class B findings (Use Q8 modifier) two points required


   1. Advanced trophic changes (three required) such as

        Hair growth (decrease or absence)

        Nail changes (thickening)

        Pigmentary changes (discolouration)

        Skin texture (thin, shiny) or skin colour (rubor or Redness)


    2. Absent posterior tibial pulse


    3. Absent dorsalis pedis pulse


C.   Class C findings (use Q9 modifier) (one Class B and two Class C findings required)


    1. Claudication

    2. Temperature changes (cold feet)

    3. Paresthesias (abnormal spontaneous sensations in the feet)

    4. Burning 

    5. Edema


Medical necessity is very important while coding podiatry claims. Please check CMS for LCD or NCD details.