Billing and Collections Q&A

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By Lisa Lake-Salmon
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Billing for O&P devices seems to get more complicated by the day. Count on Got FAQs? to help answer your toughest questions. This month's column addresses your questions about billing for a custom-fabricated item that was ordered but not furnished and ICD-10 and billing codes to be used for a CROW claim reimbursement.

Q: My husband is a practitioner in Alabama and I have worked in his office for the last four years. I had an incident occur that we have never encountered and I am not sure how to handle it. My husband made a brace and spent time fabricating and customizing it to meet the patient's needs. The day the patient was scheduled to pick up the brace we received a call that the patient had passed away the night before. We are compassionate people and I understand this can happen. Is there anything we can do regarding reimbursement? Any advice you provide is greatly appreciated.

A: According to the Medicare Supplier Manual, Chapter 5, Number 4, if a custom-made item is ordered but not furnished due to the patient's death, a change in the patient's condition, or the beneficiary cancels the order, you can still submit your claim to Medicare to be considered for payment. Your date of service would be the date the patient died, the date you learned of the item's cancellation, or the date that you learned that the item was no longer reasonable and necessary or appropriate for the patient's condition. The Medicare allowed amount is based on the services furnished and materials used, up to the date you learned of the patient's death, the order was cancelled, or that the item was no longer reasonable and necessary or appropriate. Medicare takes into account any salvage value of the device. You should always ensure your documentation to support the claim is clear and concise. To access the complete policy regarding Artificial Limbs, Braces, and Other Custom-Made Items Ordered but Not Furnished, visit www.oandp.com/link/325.

Q: I want to thank you for providing valuable advice to O&P providers and their staff for so long. The practitioner for whom I work at a facility in New York recalls seeing a previous article about billing and diagnoses that may be considered medically necessary for a Charcot Restraint Orthotic Walker (CROW). I am not sure which International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes may justify the necessity for this orthosis. Are there any additional codes I bill with this device?

A: Code L-4631 (ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated) describes a CROW. L-4631 is covered for beneficiaries who are ambulatory with weakness or deformity of the foot and ankle, who require stabilization for medical reasons and have the potential to benefit functionally. It is designed to maintain the foot at a fixed position of 0 degrees (i.e., perpendicular to the lower leg). L-4631 includes all additions, including straps and closures. No additional codes may be billed. According to Medicare's Local Coverage Determination (LCD) for Ankle-Foot/Knee-Ankle-Foot Orthosis, ICD-10 codes to use for L-4631- which do not guarantee payment- are: A52.16 Charcot's arthropathy; M14.661 Charcot's joint, right knee; M14.662 Charcot's joint, left knee; M14.669 Charcot's joint, unspecified knee; M14.671 Charcot's joint, right ankle and foot; M14.672 Charcot's joint, left ankle and foot; and M14.679 Charcot's joint, unspecified ankle and foot. For complete policy coverage, which was last updated March 3, visit www.oandp.com/link/326

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.