Podiatry Billing for Foot and Ankle Practices
Written by Corey Blackburn, DPM, Founder
Prairie Specialty Billing bills podiatry claims for practices that treat foot and ankle conditions, diabetic foot care, wounds, and office procedures. Founder Corey Blackburn, DPM, still practices. The team codes, checks claims before they go out, submits them, posts payments, and works denials for podiatry practices in all 50 states.
What do Medicare modifiers Q7, Q8, and Q9 mean?
Medicare uses these modifiers when routine foot care is billed with a covered condition and documented class findings. Q7 is one Class A finding. Q8 is two Class B findings. Q9 is one Class B finding and two Class C findings. The chart has to record the findings that match the modifier. A Class A finding is a nontraumatic amputation of the foot or an integral skeletal portion of it. Class B findings include an absent posterior tibial pulse, an absent dorsalis pedis pulse, or advanced trophic changes. Class C findings include claudication, temperature changes, edema, paresthesias, and burning.
What has to be in the note for an at-risk foot?
The note has to support the diagnosis, the class findings when a Q modifier is used, and the service performed. A Q modifier without those findings in the record is a documentation problem. Peripheral neuropathy without vascular impairment is not documented the same way as a Q-modifier claim.
How are orthotics, DME, and wound care billed differently from an office visit?
An office visit, a wound or debridement, and durable medical equipment are not the same claim. Orthotics and diabetic footwear often bill as DME, with supplier enrollment and a medical-necessity note that an evaluation-and-management claim does not use. Wound and debridement claims need the depth and extent the code describes. We keep those paths separate.
Routine foot care
Routine foot care is often excluded from Medicare unless an exception applies. Q7, Q8, and Q9 exist to report the class findings that support that exception. We do not add those modifiers unless the record supports them. The Medicare Administrative Contractor local coverage article controls the claim, and those articles change. We use the article for the practice contractor instead of one national template.
A practicing podiatrist as founder
Corey Blackburn, DPM, also practices at Prairie Foot and Ankle: prairiefoot.com. Prairie Specialty Billing is the billing company. The practice site is separate from this page.