Got FAQs?

Content provided by The O&P EDGE
Current Issue - Free Subscription - Free eNewsletter - Advertise

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

Bookmark and Share