Got FAQs?

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By Lisa Lake-Salmon

Denials are difficult to identify and time consuming to appeal. When you have questions, count on Got FAQs to help keep your claims on track. This month's column tackles your questions on Medicare denial codes, ABN forms, Medicares knee orthosis policy, and more.

Q:  I read your column monthly, and I don't remember seeing a question relating to Medicare denial codes. Is there a denial code index that can be found online? I have a claim that was denied for date of service June 2008. Can I still bill Medicare for it, or is it too late?

A:  To better understand the denial codes you are receiving on your Medicare remittance advice, visit www.wpc-edi.com/codes  or www.cmsremarkcodes.info . For additional information, you may also view the Medicare publication "Understanding the Remittance Advice (RA): A Guide for Medicare Providers, Physicians, Suppliers, and Billers," which is available for download at www.cms.hhs.gov/mlnproducts/downloads/ra_guide_full_03-22-06.pdf . Claims with a June 2008 date of service may be submitted to Medicare through December 31, 2009.

Q:  I am a small provider in Florida and rarely use the Advance Beneficiary Notice (ABN) form. I was told the form has changed. Where can I find the new form, and how and when should it be used?

A:  Effective March 2008, Medicare issued a revised ABN form. For more information regarding the revised ABN and to download a sample form, visit www.cms.hhs.gov/transmittals/downoads/r158cp.pdf . Additional information and other limitation of liability notices can be found at www.cms.hhs.gov/bni

Q:  In the last few months, we have furnished several knee orthoses (L-1843) to Medicare patients. Our claims are still being denied as CO-50 (not medically necessary) even though we are filing the claim with the KX and RT modifier. What are we doing wrong?

A:  You did not mention the diagnosis (DX) code used with these claims. The patient's diagnosis code may not be considered medically necessary. A knee orthosis with an adjustable flexion and extension joint that provides both medial-lateral and rotation control (L-1843, L-1845) is covered for a patient who is ambulatory and has knee instability due to a condition specified in one of the following diagnoses: 340, 342.9, 343.9, 344.1, 355.0, 355.2, 844.0. There are several other diagnoses that the patient could have that would warrant the medical necessity of L-1843. For additional information on coding and coverage, review the complete knee orthosis policy at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=22664&lcd_version=4&show=all.

Q:  What addition codes can I bill Medicare for when using L-1846 as my base code?

A:  When billing L-1846, the following addition codes are eligible for separate payment: L-2385, L-2390, L-2395, L-2397, L-2405, L-2415, L-2492, L-2785, L-2795, and L-2800. For a detailed list of addition codes which describe components or features that can be incorporated in the specified custom-fabricated base orthosis, refer to Medicares knee orthosis policy at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=22664&lcd_version=4&show=all.

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 lisa@opedge.com or visit www.acc-q-data.com