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Got FAQs?
By Lisa Lake-Salmon  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: If I have a patient who requires a shoe attached to a brace, how
do I bill Medicare for a pair of shoes if the patient only has one
leg brace?
A: If you give the patient a pair of shoes,
Medicare will only reimburse you for the one shoe that is attached
to the integral leg brace. If you give the patient an ABN form,
letting him know that he would be required to pay for the other
shoe, you may then bill Medicare for the shoe that is attached to
the brace with the KX modifier along with either the RT or LT
modifier. The other shoe should be billed on a separate line with a
GA modifier, along with your RT or LT modifier. Medicare will deny
the line item with the shoe not attached to the brace, but this
will allow you to bill the patient for the one shoe. You can only
bill the patient for the one shoe if you have an ABN form signed on
file and you billed with the GA modifier.
Q: I am a provider of spinal orthoses. Have there been
any deletions of HCPCS Codes for 2004?
A: Effective April 1, 2004, the following codes
have been deleted for spinal orthotics: L-0476, L-0478, L-0500,
L-0510, L-0520, L-0530, L-0540, L-0550, L-0560, L-0561, L-0565,
L-0610, L-0620, and L-0960. These codes will be considered invalid
by Medicare for claims submission on or after April 1, 2004.
Q: As an O&P provider, I receive many requests to
deliver items to a patient while he or she is in the hospital and
find I have a hard time being paid for these services by Medicare.
Please advise me how to properly bill Medicare for these
services.
A: According to DMEPOS, you may deliver items
to a patient during an inpatient stay at a hospital--as long as the
delivery date is within two days prior to discharge and the item is
needed for fitting and training purposes. When billing Medicare,
your date of service should be the patient's discharge date instead
of date of delivery. Your place of service should either be "11"
(office) or "12" (home). You should have all the proper
documentation in the patient file to support this information.
We invite readers to ask any questions you 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 is Executive VP of Acc-Q Data, Inc. 
Table Of Contents - April 2004
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