Got FAQs?

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Denials are difficult to identify and time consuming to appeal. Whether you have a question about L-Codes and modifiers or billing for products destroyed by natural disasters, count on "Got FAQs?" to help keep your office running smoothly.


Q: In July 2008, it became necessary to add the KX modifier to claims for knee orthoses. Can you tell me the coverage criteria/corresponding documentation regarding L-1815 through L-1820 and L-1830?

A: According to the most current knee orthosis policy, a knee immobilizer without joints (L-1830) is covered if all of the following criteria are met:

  • The patient has had a recent injury to or surgical procedure on the knee.
  • The patient requires a brace with range of motion (ROM) limitations.
  • The patient has one of the following diagnoses: 714.0 to 714.4, 715.16, 715.26, 715.36 to 715.96, 717.0 to 717.5, 717.7, 717.81 to 717.9, 727.65, 733.15, 733.16, 733.49, 733.93, 755.64, 821.20, 821.39, 822.0, 822.1, 823.00 to 823.42, 836.0 to 836.69, 996.4, 996.66, 996.77, V4365

The complete coverage and documentation requirements regarding knee orthoses is available at www.cignagovernmentservices.com/jc/coverage/LCDinfo.html

Q: I have a patient whose prosthetic leg was destroyed in one of the recent hurricanes. How do I let Medicare know that the prosthesis I am billing for is a replacement for the one the patient lost? I know patients are only covered for one every so many years.

A: When billing Medicare, you would need to add modifier CR (catastrophe/disaster related) to the usual modifiers you would list on your claim. You can also put a notation in the additional documentation field of your claim. The CR modifier informs Medicare that you are billing for a disaster claim.

Q: Do you know of a K-Code I could use for replacement interface material? I have never heard of K-Codes; we only use L-Codes.

A: Effective April 1,2008, Medicare established K-0672 (addition to lower-extremity orthosis, removable soft interface, all components, replacement only, each). Coverage of a removable soft interface (K-0672) is limited to a maximum of two per year beginning one year after the date of service for initial issuance of the orthosis. Additional replacement interfaces will be denied as not medically necessary.

Q: I recently billed South Carolina Medicaid for L-3920, and my claim was denied as invalid procedure code and/or modifier. The modifier I used was NU. Do you know what I did wrong?

A: The code you are using to bill L-3920 (hand finger orthosis, knuckle bender with outrigger, prefabricated) is no longer a valid code and has been changed to

Lisa Lake-Salmon is the executive vice president of ACC-Q-Data, which provides billing, collections, and practice management software. She 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,contactlisa@opedge.com

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