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Billing and Collections Q & A
By Lisa Lake-Salmon  Q: I read in a previous issue of The O&P
EDGE that Medicare no longer pays separately for L-3845 and
was wondering if there are other L-Codes in the WHFO
(wrist-hand-foot orthosis) category for which it will not pay
separately?
A: Effective January 1, 2008, the following
codes are no longer paid for separately, and are included in the
allowance for the orthosis base code: L-3810, L-3815, L-3820,
L-3825, L-3830, L-3835, L-3840, L-3845, L-3850, L-3855, and
L-3860.
Q: I am a billing manager for an O&P
practice. I recently read about a new code for replacement
interface material and now I cant find it anywhere on the DMERC
website. Are you familiar with this? Do you know what the new code
is? Does it replace another code? Any help would be greatly
appreciated.
A: Effective April 1, 2008, a new K-Code was
establishedK-0672 (addition to lower-extremity orthosis, removable
soft interface, all components, replacement only, each). You may
find more information regarding this at www.cms.hhs.gov/Transmittals/downloads/R1441CP.pdf
Q: My Medicare enrollment package was returned
to me, stating it was incomplete. I was told I needed an NPI number
before my application can be processed. Can you tell me where I can
go to apply for one? I did not realize I needed this before I sent
in my enrollment application.
A: Medicare will not issue a new provider
number unless you have already received your NPI number. You may
apply for an NPI number online at http://nppes.cms.hhs.gov. If you
have any questions regarding your NPI number you may also contact
the National Provider Enumerator Customer Service at
800.465.3203.
Q: I recently graduated, and this is the first
preparatory BK (L-5510) for which I am billing. Are there any
L-Codes for the additions I cant bill for? I do not want my first
Medicare claim denied; I have to pay the manufacturers for the
materials. I just want to make sure all the codes I am billing for
are correct.
A: Welcome to the world of O&P. When
billing Medicare for an initial BK prosthesis (L-5500) or a
preparatory BK prosthesis (L-5510, L-5540), the following codes, if
billed in conjunction with the above-mentioned base code, will deny
as not medically necessary: L-5629, L-5638, L-5639, L-5646, L-5647,
L-5704, L-5785, L-5-962, and L-5980. Remember to bill with a RT or
LT modifier and a K modifier for the patients functional level.
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 - May 2008
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