Got FAQs?
By Lisa Lake-Salmon  Denials are difficult to identify and time
consuming to appeal. Because we know you want to do it right the
first time so your payments are not delayed, count on "Got FAQs?"
to answer your most pressing Medicare and reimbursement
questions.
Q: We have started a patient services division
to fit our custom breast prosthesis. We know how to bill for the
prosthesis but are unsure what else we should bill for and under
what code. Can we bill for casting time, fitting time, and the
associated supplies?
A: You did not specify if you were billing
DMERC or a commercial carrier; therefore, I will give you
Medicare's guidelines. Casting and fitting are included in the
reimbursement for the prosthesis. In addition to the prosthesis
(L-8030), you can either bill for a mastectomy bra (L-8000, L-8001,
or L-8002) or adhesive skin support attachment (A-4280), but not
both.
Q: We are restructuring our company and have
changed from a limited liability corporation (LLC) to an S
corporation (S-corp). We received a new tax ID and are not sure if
we need to send a W-9 form to Medicare to advise of this change or
if we can just call them directly.
A: DMEPOS suppliers must notify the National
Supplier Clearinghouse (NSC) within 30 days of changes in their
enrollment information. If your tax identification number is
changing, you will have to fill out a new supplier enrollment form
(CMS 855-S), which can be found online at www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf.
You may contact the NSC directly at 866.238.9652.
Q: Can you advise us as to what is required for
L-4210 (unlisted parts)? Can we bill with labor (L-4205)? Do they
need modifiers or require an invoice?
A: L-4210 requires an RP modifier, then RT or
LT. You will need a specific breakdown of parts and/or components
being replaced or repaired. This documentation will go in your note
segment field, also known as the HAO field. In addition to L-4210,
you should bill L-4205 (labor for repair/replacement of parts) with
the same modifiers as L-4210. When billing for L-4205, each unit
represents 15-minute segments. You must give a breakdown of exactly
what you repaired for the labor time being billed.
Q: If the physician who treats a patient's
diabetes sends the patient to a podiatrist for issues relating to
the feet, is it acceptable to use the podiatrist's notes or patient
records to support medical necessity?
A: The documentation in the patient's record
from the podiatrist would be considered acceptable. The particular
type of footwear (shoes, inserts, modifications) must be prescribed
by a podiatrist or other qualified physician, who is knowledgeable
in the fitting of diabetic shoes and inserts. The footwear must be
fitted and furnished by a podiatrist or other qualified individual
such as a pedorthist, orthotist, or prosthetist.
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 profession 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 - March 2008
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