May 2011 Issue
Denials are difficult to identify and time-consuming to appeal. When denials have you at your wit's end, "Got FAQs?" can help you get your billing back on track. This month's column addresses your questions about L-Codes for lower-limb prostheses, saving patient files, billing for osteogenesis stimulation, and what K-level modifiers to use when billing for lower-limb prosthetic devices.
Q: I read your column religiously and have not noticed any mention of code changes for lower-limb prostheses. Are there any new L-Codes for 2011 for lower-limb prostheses? Can you provide me with the link so I can see all the changes for 2011?
A: The only new L-Code for lower-limb prostheses for 2011 is L-5961 (addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control). You may view all of the 2011 Healthcare Common Procedure Coding System (HCPCS) code additions and deletions by visiting www.cignagovernmentservices.com/jc/pubs/news/2011/0111/cope13709.html
Q: We are moving our office to a smaller location and want to dispose of some of our old records. I am not sure how long we are required to keep our patient files. Do you know where I can find this information? How long does Medicare require you to keep patient files?
A: State laws generally govern how long medical records should be kept. However the Health Insurance Portability and Accountability Act (HIPAA) of 1996 included Administrative Simplification provisions, which require a covered entity billing Medicare to keep required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later. HIPAA requirements preempt state laws if states require shorter periods. You may find this information in the Winter 2011 issue of the DME MAC Jurisdiction C Insider on page 26. Go to www.cignagovernmentservices.com/jc/pubs/insider/2011_insider_Winter.pdf
Q: We have billed Medicare for E-0748 numerous times, and we always receive denials. We are billing with modifiers NU KX, and I thought our patients had met the coverage guidelines. What modifiers do we need to bill with and what are the guidelines for this to be covered? I do not understand why I cannot get one claim paid.
A: An osteogenesis stimulator, electrical, non-invasive, spinal applications (E-0748) is considered medically necessary when the patient has met any of the following failed spinal fusion surgeries (ICD-9 code V45.4) where a minimum of nine months have elapsed since the last surgery, or following a multilevel spinal-fusion surgery (ICD-9 code V45.4), or following spinal-fusion surgery where there is a history of a previously failed spinal fusion at the same site. The correct modifiers to use would be either NU KF or RR KF.
Q: I am new at billing for prosthetics, and I have received denials regarding the K-level modifiers I bill with. I am told that the L-Codes for feet require this modifier, and I am not sure what codes get what modifier. The practitioner provides me with the K modifier I should use. All the patients I have billed for were either a K-2 or K-3 modifier.
A: An external keel SACH foot (L-5970) or single-axis ankle/foot (L-5974) is covered for patients whose functional level is 1 or above. A flexible-keel foot (L-5972) or multiaxial ankle/foot (L-5978) is covered for patients whose functional level is 2 or above. A microprocessor-controlled ankle foot system (L-5973), energy-storing foot (L-5976), dynamic response foot with multiaxial ankle (L-5979), flex foot system (L-5980), flex-walk system or equal (L-5981), or shank foot system with vertical loading pylon (L-5987) is covered for patients whose functional level is 3 or above. To view the lower-limb prostheses policy, click here.
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