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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 L-1855 was no longer a valid code, and the new code is L-1846. Do you know what codes we can bill for additions when using L-1846? It is not easy keeping up with Medicare changes.
A:
The additional codes that are eligible for separate payment when billing L-1846 as your base code are as follows: L-2385, L-2390, L-2395, L-2397, L-2405, L-2415, L-2492, L-2785, L-2795, and L-2800. Additional codes may be separately payable if they are provided with the related base-code orthosis and the addition is considered medically necessary.
Q:
I am interested in reading as much as possible on competitive bidding. Are there any websites you would recommend I go to regarding this? I am very concerned on how this will affect my practice and future as an O&P practitioner.
A:
All providers can find detailed information regarding competitive bidding at
www.dmecompetitivebid.com
or
www.cms.hhs.gov/CompetitiveAcqforDMEPOS/
. A number of articles written on this topic can be found at
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0714.pdf
. For information on program instructions and product categories included in the first round of competitive bidding, see
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5574.pdf
Q:
I received a denial from Medicare on L-3930 and was told it was no longer a valid code. When I asked the customer service representative what the new code was, I was amazed when she stated she could not tell me. Do you know what code replaced L-3930?
A:
Effective January 1, 2008, L-3930 is no longer a valid code. The new code is L-3931 (wrist-hand-finger orthosis, finger extension, with wrist support, prefabricated, includes fitting and adjustments).
Q:
I recently opened an O&P practice in Georgia and have received a few referrals for a knee orthosis L-1845. Do you know what diagnosis the patient needs to have in order for Medicare to consider this for payment?
A:
According to CMS guidelines, L-1845 is covered for a patient who is ambulatory and has knee instability due to a condition specified in one of the following diagnoses: 340 (multiple sclerosis), 342.9 (hemiplegia unspecified), 343.9 (infantile cerebral palsy unspecified), 344.1 (paraplegia of both lower limbs), 355.0, and 355.2 (mononeuritis of lower limb).
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. For more information, contact
.
Table Of Contents - June 2008
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