Got FAQs?
By Lisa Lake-Salmon .jpg) Claim denials are difficult to
identify and time-consuming to appeal. Don't let them become the
bane of your existence. When you need answers to your most pressing
questions, count on "Got FAQs?" to help get you back on
track.
Q: I submitted a claim to Durable Medical
Equipment Regional Carrier (DMERC) for lower-limb prostheses, and
all the codes were paid except the codes for the socks (L-8430 and
L-8480). I was told by my practitioner that all codes should be
paid, even though the patient was in a skilled nursing facility at
the time of service. If this is true, why did Medicare deny these
codes?
A: Your practitioner was partially correct.
Medicare will pay for prostheses while a patient is in a skilled
nursing facility; however, it does not cover the socks (L-8430 and
L-8480). The socks are usually covered by the facility. You may
bill the facility directly, or you may bill DMERC and forward the
denial to the facility.
Q: I received a non-covered denial for
compression stockings (A-6531) along with the AW modifier. Can you
explain to me why they would still deny my claim even though I used
the proper Healthcare Common Procedure Coding System (HCPCS) code
and modifier as told by a Medicare representative?
A: You did not mention the diagnosis code you
used when submitting your claim. When billing for compression
stockings (A-6531 AW), your claim will be covered if your patient
has the following diagnosis: 459.31 and 459.33. Since you billed
with the proper HCPCS code and modifier, you may want to check what
diagnosis code you submitted. Please note that diagnosis code 459.3
must be taken to the fifth digit in order to be paid.
Q: Aloha. I received a denial from Blue Cross
Blue Shield (BCBS) of Hawaii for L-6840 and was told this is no
longer a valid code. Of course, they will not tell me what code
replaced it. Are you aware of the code that replaced L-6840? Any
information would be greatly appreciated. Mahalo!
A: Effective January 1, 2007, L-6840 (terminal
device, hand, Becker Imperial) is no longer a valid code and was
replaced by L-6708. Go to www.palmettogba.com and click on the SADMERC
link (listed under "Other Partners"). Then click on topic heading
DMECS to search for valid codes and their effective date.
Lisa Lake-Salmon is the executive vice president of
ACC-Q-Data, which provides billing, collections, and practice
management software and has been serving the O&P industry for
more than a decade. We invite readers to write in and ask any
questions they may have regarding billing, collections, or related
subjects. For more information, contact lisa@opedge.com 
Table Of Contents - September 2007
|
