Originally shared in the July/Aug 2020 PPMA Newsletter

Response provided by Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Q: As we get further into this pandemic, I am seeing more diabetic patients who have had their PCP appointments delayed for longer periods of time. An increasing number are now not seeing their PCP within the six-month time frame required for a Q8 or Q9 modifier as required by CMS for DM footcare coverage, thereby causing them to self-pay due to a situation that is out of their control. Has CMS adjusted to this situation with any sort of waiver during the pandemic?

A: No, no change has been made. When the patient qualifies for footcare via the Routine Foot Care pathway, and their qualifying condition has an asterisk in the policy, the patient must be under the active care of a doctor of medicine or osteopathy (MD or DO) or NPP for the treatment and/or evaluation of the complicating disease process during the six- month period prior to the rendition of the routine-type service or if the patient had come under a physician’s or NPP’s care shortly after the services were furnished. The PA Novitas policy is here: https://tinyurl.com/ybjdp8vl. 

One thing to take note of given the COVID-related situation you are encountering: Nowhere does it say this visit has to have been face-to-face or in-person. Therefore, a non-face-to-face visit counts. So, if the patient has not “seen” the provider who is caring for their qualifying condition in the last six months, be sure to also check for any non-face-to-face visits that may have occurred with that provider.

Because the policy as-is does not say the date last seen needs to have been an in-person or face-to-face visit, we do not need what follows, but it will make you feel better if you have any hesitation about what I wrote above. 

On April 30, 2020, CMS released, “Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency and Delay of Certain Reporting Requirements for the Skilled Nursing Facility Quality Reporting Program Interim Final Rule with Comment Period,” which can be found here: https://tinyurl.com/y9m9o4o4.

On page 157, it says, “We finalized on an interim basis that to the extent an NCD or LCD (including articles) would otherwise require a face-to-face or in-person encounter or other implied face-to-face services, those requirements would not apply during the PHE for the COVID-19 pandemic."