08/15/2018

Billing Medicare for At Risk Foot Care-173.89, L60.2, L84, G0127, 11720 and 11055

How should a Medicare claim be billed for at risk foot care DX: I73.89,L60.2,L84 and CPT codes G0127, 11720,11055. Where and which modifiers should be used on which lines of service? I know appropriate Q modifiers but which X modifiers for 3 lines

The routine foot care claim should be coded as follows in order to be reimbursed by Medicare in the following order:

• CPT 11055:
• Primary diagnosis should be I73.89, secondary diagnosis should be L84
• The Q modifier should be the only modifier reported
• CPT 11720:
• Primary diagnosis should be B35.1, secondary diagnosis should be I73.89
• For modifiers:
• XU should be reported (service that is distinct because it does not overlap usual components of the main service) as the primary modifier- the removal of corns/calluses is performed on the same structure as nail care, but is not considered an overlapping service
• Q modifier secondary
• CPT G0127:
• Primary diagnosis should be I73.89, secondary diagnosis should be L60.2
• For modifiers:
• XU should be reported (service that is distinct because it does not overlap usual components of the main service) as the primary modifier- nail trimming and debridement are two distinct services and are performed on different nails
• Q modifier secondary

Please click on link for the LCD policy

Rfc And Debridement Of Nails L33636 01.03.18