Got FAQs

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By Lisa Lake-Salmon

Denials are difficult to identify and time-consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, and increased billing errors, running an O&P shop gets more complicated each year. Count on 'Got FAQs' to help you sort through the complexities.

Q: I am billing an upper-limb prosthesis to Medicare, and I am not sure what modifiers to use. Some of the codes I will be billing are L-6955, L-6682, L-7404, L-6675, and L-6691. When indicating modifiers, do I need to inform DMERC what level amputee the patient is as I do with lower-limb prostheses?

A: For codes L-6955, L-6682, L-7404, L-6675, and L-6691, the only modifiers Medicare requires are RT or LT. As of January 2007 there were several code changes made to upper-limb prostheses, so you may want to refer to your current DMERC Healthcare Common Procedure Coding System (HCPCS) master list to view all added and deleted codes. [ Editor's note: For more information on HCPCS, visit www.cms.hhs.gov/MedHCPCSGenInfo ]

Q: I received a denial from Medicare CO-50 not medically necessary for L-0450, and I am not sure why my claim is being denied.

A: You did not specify what DX code you used to bill L-0450, and since there are no modifiers you would use when billing this code, it may be the DX code you submitted with your claim. According to DMERC guidelines, L-0450 is covered for the following patient needs:

  • To reduce pain by restricting mobility of the trunk.
  • To facilitate healing following an injury to the spine or related soft tissues.
  • To facilitate healing following a surgical procedure on the spine or related soft tissue.
  • To otherwise support weak spinal muscles and/or a deformed spine.

Q: I receive my Medicare payments electronically. I know you had mentioned this in your column before, but I do not recall the answer you had given. Is it necessary to notify Medicare if I relocate my practice to a new address, as I do not receive anything by mail from DMERC?

A: According to the Medicare DMEPOS Supplier Standard #2, suppliers are required to inform the National Supplier Clearinghouse (NSC) of any location change within 30 days. I suggest you notify the NSC as soon as possible. Failure to do so could result in the termination of your supplier number.

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