Billing and Collections Q&A

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By Lisa Lake-Salmon

Billing for O&P devices and care is complicated. Count on "Got FAQs?" to help ensure you are using the most current information when preparing your claims. This month's column answers your questions about addition codes for custom-fabricated orthoses and use of a supplier number when a practice changes ownership.

Q: We bill for custom-fabricated orthoses, and I was asked to verify what addition codes I can bill with these orthoses for a Medicare beneficiary.

A: When billing for codes L-1834 (knee orthosis, without knee joint, rigid, custom-fabricated), L-1840 (knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated), L-1844 (knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated), L-1846 (knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated), and L-1860 (knee orthosis, modification of supracondylar prosthetic socket, custom-fabricated (SK)), addition codes may be payable separately if they are provided with the related base code, the base code for the orthosis is reasonable and necessary, and the addition is reasonable and necessary. Addition codes for L-2385 (addition to lower extremity, straight knee joint, heavy duty, each joint) and L-2395 (addition to lower extremity, offset knee joint, heavy duty, each joint) are covered only for beneficiaries who weigh more than 300 pounds. The following addition codes describe components or features that can be incorporated in the specified custom-fabricated base orthosis.

Base code: L-1834. Addition code: L-2795.
Base code: L-1840. Addition codes: L-2385, L-2390, L-2395, L-2397, L-2405, L-2415, L-2425, L-2430, L-2492, L-2755, L-2785, and L-2795.
Base code: L-1844. Addition codes: L-2385, L-2390, L-2395, L-2397, L-2405, L-2492, L-2755, and L-2785.
Base code: L-1846. Addition codes: L-2385, L-2390, L-2395, L-2397, L-2405, L-2415, L-2492, L-2755, L-2785, L-2795, and L-2800.
Base code: L-1860. Addition code: None.

Q: We are located in Georgia, and my husband recently took over the practice at which he had been employed. My husband was told that he could continue to use the previous owner's Medicare supplier number with no changes. Can you let me know if my husband, who is a CPO, needs to do anything to let Medicare know he bought the practice?

A: When there is a change of ownership, a new supplier number must be issued unless the new owner assumes all liabilities and the tax identification number of the existing supplier. Otherwise, the new owner may not use the existing supplier number. The new owner must submit form CMS 855S, Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers, to the National Supplier Clearinghouse (NSC) within 30 days of the ownership change along with a bill of sale, articles of incorporation filed with the state, and any other documents that show the exact nature of the transaction. If there is a change in the tax identification number, the outgoing owner must notify the NSC by completing and submitting form CMS 855S as a voluntary termination of the supplier billing number; the old supplier number will be inactivated. If the NSC determines the new owner has met all requirements, the new number will be effective from the date of the ownership change. Claims for items furnished between the date of the ownership change and the issuance of the new supplier number may be submitted to the durable medical equipment (DME) contractor once the supplier has received the new number. To obtain form CMS 855S, visit www.oandp.com/link/227

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