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:I am a relatively new prosthetist
and was wondering if Medicare will cover repairs or adjustments
made to a patient's prosthesis?
A: Any repairs or adjustments made to the
prosthesis within the first 90 days of fitting are not paid for
separately; Medicare considers that as included in the
reimbursement for the prosthesis. After the initial 90 days, you
would then use either L-7510 (repair) and/or L-7520 (labor per 15
minutes).
You will need to explain to Medicare in your additional
documentation exactly what the repairs were for. Remember to always
use the proper modifiers: RP (repair); RT or LT (specifies which
leg); K1, K2, K3, or K4 (what functional level).
Q:Can you help me settle a dispute
between myself and a colleague? How long is a provider required to
keep proof-of-delivery documentation on file?
A: According to DMERC, suppliers are required
to maintain proof of delivery documentation in their files for
seven years.
Q:I billed a breast prosthesis to
Medicare for the first time, and my claim was denied for CO-16. I
contacted Medicare and was told my claim was missing the
appropriate modifier. Which modifier do I use?
A: When billing for a breast prosthesis, you
must use either the RT (right) or LT (left) modifier. If the
patient had a bilateral mastectomy, you must use both modifiers on
one line item and your number of units should be two.
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 Vice President, Acc-Q-Data Inc. 
Table Of Contents - June 2004
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