Billing & Collections Q&A

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By Lisa Lake-Salmon

Frustrated by denials? When you need help with the complicated world of O&P billing, "Got FAQs?" has the answers you need to help keep your O&P practice running smoothly. This month's column tackles your questions about coding for FES devices, diagnosis codes, and definitions for various devices.

Q: What is the correct code for billing Medicare for a functional electrical bone- growth stimulator? We have been going back and forth with Medicare about this for six months. This was an expensive item to provide. We thought we had established what we needed for Medicare but continue to get the runaround.

A: Effective January 2009, Medicare established a new code, E-0770 (functional electrical stimulator, transcutaneous stimulation of nerve and/or muscle groups, any type, complete system). To review Medicare's Medical Policy regarding the E-0770 in its entirety, visit www.medicarenhic.com/dme/medical_review/~

Q: We provided a patient with a custom AFO, and the physician had written "right foot drop" as the diagnosis. We contacted the physician's office to get the actual code for foot drop, and he did not know. Where can we find the correct code?

A: Foot drop is a condition in which there is weakness and/or lack of use of the muscles that dorsiflex the ankle, while there is still the ability to bring the ankle to zero degrees by passive range of motion. There are several codes you could use, ranging from 730 to 739 (osteopathies, chondropathies, and acquired musculoskeletal deformities). To verify current diagnosis codes, you can use either icd9cm.chrisendres.com/icd9cm or www.icd9data.com

Q: Can you help me get the full definition for L-5785 in reference to a vacuum pump? We have never billed for this before.

A: The definition for L-5785 is "addition, exoskeletal system, below knee, ultra light material titanium, carbon fiber or equal." You can use one of two Healthcare Common Procedure Coding System (HCPCS) codes to describe a vacuum pump. They are L-5781 (addition to lower-limb prosthesis, vacuum pump, residual-limb volume management and moisture evacuation system), and L-5782 (addition to lower-limb prosthesis, vacuum pump, residual-limb volume management and moisture evacuation system, heavy duty.) To check if your HCPCS code is still valid, visit www.dmepdac.com/dmecsapp/do/search or www.cms.hhs.gov/hcpcsreleasecodesets/anhcpcs/list.asp

Q: I am having a debate with a colleague of mine regarding Medicare's definition of a custom-fitted orthotic. Please clarify, as we have a round of golf riding on this and would greatly appreciate your input.

A: According to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Quality Standards October 2008, the definition of custom fitted is "a prefabricated device, which is manufactured in quantity without a specific patient in mind. The device may or may not be supplied as a kit that requires some assembly and/or fitting and adjustment, or a device that must be trimmed, bent, molded (with or without heat), or otherwise modified by an individual with expertise in customizing the item to fit and be used by a specific patient."

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