November 2010 Issue
Are billing questions giving you a headache? Are you up to your eyeballs in denials? "Got FAQs?" is here to help you get your claims back on track. This month's column tackles your questions about billing for diabetic shoes, denial codes, and knee orthosis addition codes.
Q: I am having a horrible time getting paid properly by Michigan Medicaid for diabetic shoes. I bill A-5500 RT LT (two units) and A-5512 RT LT (six units), and they are consistently paying as one unit for A-5500 and three units for A-5512. When I submit a replacement claim with resubmission code seven and the original transaction control number (TCN), the form is being denied as a duplicate. I am so frustrated, I don't know what to do! Can you give me any insight?
A: According to the Michigan Policy Manual for a depth shoe, three inserts would be separately reimbursable in addition to the non-customized insert that is included with the shoe. For a custom-molded shoe, two inserts would be separately reimbursable. For A-5500 LT RT, one per year is allowed, and for A-5512 LT RT, up to three per year are allowed. You may view this information at www.michigan.gov/documents/mdch/Supplier_January_2010_314470_7.pdf
Q: I seem to be getting a large amount of CO-16 and CO-18 denial codes on my transcripts from Medicare. We recently installed a new computer processing module, and I do not know if I am doing something wrong. Each time I bill electronically, I always run an error report and nothing shows up. I have no idea if I am billing this incorrectly.
A: According to the Medicare Claim Adjustment Reason Codes, CO-16 means "claim/service lacks information which is needed for adjudication." At least one Remark Code must be provided (may be comprised of either the National Council for Prescription Drug Program (NCPDP) Reject Reason Code or Remittance Advice Remark Code that is not an Alert). Denial code CO-18 means "duplicate claim/service." You may find all of Medicare's adjustment codes at www.wpc-edi.com/content/view/695/1. You will have to contact Medicare to ask why your claims are being denied for lacking or missing information.
Q: I am a new billing manager for an O&P practice in Alabama. If we bill for an L-1832 knee orthosis, what addition codes can be billed with this base code? I was told Medicare does not reimburse for all of the codes. Can you tell me which codes are covered with the L-1832? Do you know where I can find a list of the DX codes the patient needs in order for this brace to be covered?
A: When billing Medicare Region C for the L-1832, the addition codes that are eligible for separate payment are L-2397, L-2795, and L-2810. If you review the LCD for knee orthoses, it will give you all base codes and the addition codes that can be billed with them. It will also provide you with the list of DX codes and the coverage criteria for each knee orthosis. You may find the LCD at www.cms.gov/mcd/viewlcd.asp?lcd_id=22664&lcd_version=18&show=all
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