The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increaseyour reimbursement. This informative column willhelp providers and their staff with a betterunderstanding of billing procedures andreimbursement strategies.
Q: I received a denial from Medicare for Code L-0315 for date of service November 30, 2005. What is the correct code to bill for that date of service?
A: The procedure code you used, L-0315, became invalid January 1, 2003. It was replaced by L-0454 effective January 1, 2003. You may refer to the DMERC Advisory, Issue 43, December 2002, to see all code changes related to the item you are trying to bill for.
Q: I am a provider in the state of Michigan and received a prescription for a bone stimulator. I billed DMERC using Code E-0747 and received a denial. I am not sure what code or modifiers I should use and what diagnosis the patient needs in order for Medicare to consider this medically necessary.
A: When billing for osteogenesis stimulator (E-0747), your claim must include the KF modifier. According to DMERC policy, an E-0747 is covered if any of the following criteria are met:
- Failed fusion of a joint other than spine (DX V45.4) where a minimum of nine months has elapsed since the patient's last surgery;
- Congenital pseudarthrosis (DX 755.8);
- Nonunion of a long bone fracture (DX 733.82) defined as radiographic proof that fracture healing has stopped for three months or more prior to starting treatment with the E-0747. If your patient's DX is nonunion of a long bone fracture (733.82), then your claim also must include the DX code for the fracture site, i.e., 810.00-810.13, 812.00-813.93, 815.00-815.19, 820.00-821.39, 823.00-824.9, 825.25, 825.35.
Important Reminder to all DMERC providers: A hold will be placed on Medicare payments for all claims from September 22, 2006, to September 30, 2006, due to the end of the federal fiscal year. All claims being held during this time will be paid on October 2, 2006. Please prepare for this interruption of your cash flow ahead of time. According to Medicare, the only claims that will be processed during this period will be full denials and no-payment claims.
We invite readers to ask questions regarding billing, collections, or related subjects. For more information, contact firstname.lastname@example.org .Acc-Q-Data provides billing, collections, and practice management software and has served the O&P industry nationwide for more than a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.