Got FAQs?

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By Lisa Lake-Salmon
Lisa Lake-Salmon

With all of the changing variables that go into O&P billing and reimbursement, running an O&P practice gets more complicated each year. Count on "Got FAQs?" to help keep your billing on track. This month's column covers your questions about L-Code allowances, delivery of custom O&P devices to inpatients at rehabilitations hospitals, and more.

Q: Can you direct me to where on the Centers for Medicare and Medicaid Services (CMS) website you found the Alabama durable medical equipment (DME) allowance for L-5973? The latest information from CMS that I have does not list the L-5973 for any states, including Alabama. I am trying to find out the CMS allowance for Colorado. The only information I have been able to find lists L-5973 as a new code for 2010. It does not list it in any fee schedules.

A: Cigna Government Services has published the first-quarter 2010 fee schedule, which lists the allowed amounts for L-5973 for both Alabama and Colorado. It can be found at www.cignagovernmentservices.com/jc/coverage/fees/2010/jc_fees_1209.pdf. The allowed amount for L-5973 is located on page 42 of the fee schedule.

Q: I'm a CO practicing at the University of Oklahoma. In one of your recent columns about custom versus non-custom AFO L-Codes, you listed various codes from L-1900 through L-2128. Has L-1945 been deleted? It's the custom-made floor-reaction code. I did not see this code listed.

A: As of first-quarter 2010, L-1945 (AFO, plastic, rigid anterior tibial section floor reaction, custom fabricated) is a valid code. The allowed amount for Oklahoma for the L-1945 is $783.73. For a complete list of valid L-Codes for AFOs, visit www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=11517&lcd_version=46&show=all

Q: I have a question regarding Medicare rules related to durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims/payments for custom O&P devices delivered to inpatients at rehabilitation hospitals prior to their discharge date. One of the rehabilitation hospitals that we work with told us that in order to receive payment for DMEPOS, the product cannot be delivered to an inpatient more than seven days prior to his or her discharge; otherwise, CMS will not reimburse for the claim, and the claim must be paid by the hospital as part of the inpatient's hospitalization. I have a further question for determination of the number of days prior to discharge: Is the triggering event the delivery of the DMEPOS device, the date the patient was first seen by the O&P practitioner, or the date the inpatient was cast in the hospital for the DMEPOS device?

A: Unfortunately, you were given incorrect information regarding this policy. The Region C Supplier Manual covers "DMEPOS and an Inpatient Stay" in chapter 6, section 13, pages 25­-26, which can be viewed at www.cignagovernmentservices.com/jc/pubs/pdf/chpt6.pdf. One of the conditions that must be met is that "the supplier delivers the item to the beneficiary no earlier than two days before the day the facility discharges the beneficiary." The general rule is that the date of service is equal to the date of delivery. However, pre-discharge delivery of items intended for use upon discharge is considered provided on the date of discharge. In this case, the date of service on the claim should be the date of discharge.

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