I am in Novitas Medicare, and when I use pain for my diagnosis in toes paired with B35.1 for the nails, bill CPT 11721 and the EMR automatically adds Q8 isn't this wrong?
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Note that there are MACs 11721 is also covered under the routine foot care exception with a systemic qualifying diagnosis and local neurological findings . Note no vascular findings. In this case, use of any Q modifier would also be inappropriate.
When billing CPT 11721 for Medicare Novitas MAC, it is appropriate to bill ICD10 B35.1 and toe pain diagnoses. In no way, should the EMR auto populate the Q8 modifier. The reason is it does not fall under the at risk option, when it is due to pain. I recommend removing the Q8 Modifier as it is inappropriate billing! Let your EMR vendor know the system is incorrectly coding your service!