The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.
Q: I recently received a denial for Code L-1885, stating "invalid procedure code." I was informed the replacement code was E-1810, so I billed it to Medicare with a LT modifier and received a denial as CO-16. I was informed that the modifier I used was incorrect. Please help, as I am very confused on what I need to do to get this paid?
A: Code E-1810 (dynamic adjustable knee extension /flexion device) needs to be billed as a capped rental on a monthly basis. Your modifiers would be RR KH LT. Each month the K modifier will be different, according to what month the rental is in. For example RR KH LT (first month), RR KI LT (second month), and so on. The allowable for the state of New York is $116.14 per month.
Q: I am located in the Region C area and received payment for a claim I billed. I noticed that when the payment came in, I had billed one of the codes at the wrong price. Is there a faster way to get Medicare to correct my claim, with the corrected price, without having to send the claim into review?
A: Yes. You can contact Medicare Region C phone review unit. Explain that there was a billing error and give the corrected price over the phone, and your claim will enter the review unit much quicker than sending it in hard copy. There are many different types of denials for which Medicare permits phone reviews. For example: If you billed with the wrong procedure code or billed with an incorrect price, you can contact Medicare phone review for correcting the claim.
We invite readers to ask questions you may have regarding billing, collections, or any other information. To send your questions or for more information, contact:lisa@westernmediallc.com
Acc-Q-Data provides billing, collections and practice
management software serving the O&P industry nationwide for
over a decade.
Lisa Lake-Salmon Executive Vice President Acc-Q-Data Inc.
