Got FAQs?

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Lisa Lake-Salmon

Billing for O&P devices seems to get more complicated by the day. Count on “Got FAQs?” to help answer your toughest questions. This month’s column addresses your questions about billing codes for K2 amputees, replacement orthopedic footwear, and Supplier Standards.

Q: I have a question regarding billing codes for K2 amputees. When I conducted my original search through the Noridian Medicare website for K2-approved codes, I found the following codes: L-5970 SACH foot; L-5974 single-axis ankle/foot; L-5972 flexible keel foot; L-5978 multiaxial ankle/foot; and L-5986 multiaxial rotation unit. I noticed that the descriptions for L-5986 and L-5978 are very similar. Endolite and Össur suggest using L-5986 for the multiaxial component for their K2 feet. In a column you recently wrote, you acknowledged that L-5978 can be an acceptable code for K2 amputees but not L-5986. Can you please clarify this for me?

A: The Local Coverage Determination (LCD) for Lower-Limb Prostheses states: ANKLES: An axial rotation unit (L-5982 through L-5986) is covered for patients whose functional level is 2 or above. View the complete LCD for Lower-Limb Prostheses on Noridian Medicare's website: www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/lower_limb_prostheses.htm

Q: I have received numerous denials when billing Medicare for orthotic footwear that we are placing for a patient who already has a brace. In response to the claim, I was told I am missing information and that I am not using the correct modifiers.

A: When billing for the replacement of orthopedic footwear that is an integral part of a leg brace, it is necessary to document in the NTE 2300 or NTE 2400 segment of the electronic claim or Item 19 of a paper claim that the shoe being replaced is part of a brace and include the Healthcare Common Procedure Coding System (HCPCS) code for the brace. For example: "Shoe being replaced is part of a brace (HCPCS L-1900)." When billing for a shoe that is an integral part of a leg brace or for related modifications, inserts, heel/sole replacements, or shoe transfer, a KX modifier must be added to the code. The right (RT) and/or left (LT) modifiers must also be used. When the same code for bilateral items (left and right) is billed on the same date of service, bill for both items on the same claim line using the RT/LT modifiers and two units of service. The RB modifier, which is for the replacement of a part of a durable medical equipment (DME), orthotic, or prosthetic item furnished as a part of a repair, must be appended to the HCPCS code for the replacement footwear.

Q: I recently opened a new practice and was told I need to give a list of the Supplier Standards to all patients. Is this true? If so, where can I find this list so I can make copies for all my patients?

A: Supplier Standard 16 states, "A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item." I recommend copying the supplier standards on the backside of the delivery ticket the patient signs. The 30 supplier standards in list format can be found at www.palmettogba.com/Palmetto/Providers.Nsf/files/DMEPOSSupplierStandards09082010.pdf/$File/DMEPOSSupplierStandards09082010.pdf

Lisa Lake-Salmon is the 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

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