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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: I have recently received a
denial from Medicare for Code L-5675, and I do not understand why
this would be denied when I was always reimbursed for this in the
past.
A: Effective Jan 1, 2005, Code L-5675 is no
longer valid. Try resubmitting your claim using Code L-5685
(Addition to lower extremity, below knee, suspen- sion sleeve,
heavy duty). This is the replacement code for L-5675 and
L-5674.
Q: If I deliver a spinal orthosis
to a patient in a hospital or Part A SNF, will Medicare reimburse
me for this?
A: According to DMERC, this would be
covered if the orthosis is medically necessary for a patient after
discharge from a hospital or Part A-covered SNF stay; the orthosis
is provided to the patient within two days prior to discharge; and
the orthosis is not needed for inpatient treatment or
rehabilitation, but is left in the room for the patient to take
home.
Q: I received an email stating that L-5685, L-5856,
and L-5857 were new HCPCS codes for lower extremity but cannot fi
nd a description for these anywhere. Do you have the descriptions
for these codes?
A: These codes are effective as of Jan 1, 2005,
and are described as follows: L-5685 (addition to lower-extremity
prosthesis, below knee, suspension/ sealing sleeve, with or without
valve), L-5856 (addition to lower-extremity prosthesis,
endoskeletal knee-shin system, microprocessor control feature,
swing and stance phase, includes electronic sensor any type), and
L-5857 (the same description as L-5856, except this is a swing
phase only.)
We invite readers to ask any questions you may have
regarding billing, collections, or any other information. To
sendyour questions or for more information, contact: lisa@westernmediallc.com
Acc-Q-Data provides billing, collections, and practice
management software serving the O&P industrynationwide
for over a decade. Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc. 
Table Of Contents - March 2005
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