When you need help with your toughest billing questions, count on ‘Got FAQs?' to provide you with the information you need to help keep your billing on track. This month's column tackles your questions about reimbursement for Ossur's Proprio Foot, diagnosis codes, new and discontinued L-Codes for 2010, and more.
Q: I have billed Medicare in the past for the Ossur Proprio Foot using L-5999 and was reimbursed. Now my claim is being denied as an invalid procedure code. Does Medicare no longer reimburse for this product? I am located in the state of Alabama.
A: Effective January 1, 2010, the Ossur Proprio Foot is billed using Healthcare Common Procedure Coding System (HCPCS) code L-5973. The allowed amount for Alabama is $15,693.16. To find out what L-Code to use for a product by a specific manufacturer, you may go to the Medicare Pricing, Data Analysis and Coding (PDAC) website, which can be found at www.dmepdac.com/dmecsapp/do/productsearch
Q: I know Medicare lists new and discontinued HCPCS codes. Are you aware of any sites that are available for free for diagnosis codes? I would like to be able to update our software before we start to receive denials for invalid diagnosis codes.
A: Medicare publishes an updated list of ICD-9-CM codes annually. The latest update—which has been effective since October 1, 2009—can be found at www.cms.hhs.gov/icd9providerdiagnosticcodes/07_summarytables.asp#topofpage
Q: In a previous article, I recall you mentioning that L-2770 will no longer be reimbursed by Medicare. The practitioners in the office continue to provide this item and then are upset when they don't get reimbursed. They would like me to provide them with some documentation confirming that Medicare no longer reimburses for L-2770. Do you know where I can find this information on Medicare's website so I can prove to them once and for all they will not get paid for this?
A: You are correct in stating that L-2770 is no longer reimbursed by Medicare. It has not been reimbursed by Medicare since July 1, 2008. You can find the documentation you are looking for on the Durable Medical Equipment Regional Carrier (DMERC) website at http://tinyurl.com/ykukk4r
Q: I am a new provider who specializes in breast prostheses. Are there any new codes or discontinued codes you are aware of for 2010? Could you please provide me with a link so that I know where to find this information in the future?
A: Effective January 1, 2010, the two HCPCS codes that were added under external breast prostheses are L-8031 (breast prosthesis, silicone or equal, with integral adhesive) and L-8032 (nipple prosthesis, reusable, any type, each). Medicare published the 2010 HCPCS Code Update that lists all the HCPCS codes that have been deleted or added effective January 1, 2010. You may find the updated list by visiting www.cignagovernmentservices.com/jc/pubs/news/2009/1209/cope11266.html
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. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact or visit www.acc-q-data.com
