Got FAQs?

The new year brings with it new L-Codes as well as discontinued ones. Rather than dealing with time-consuming denials, count on "Got FAQs?" to help keep you on top of your billing. This edition answers your questions about deleted L-Codes for 2010, denials associated with the PECOS policy, L-Codes for custom-fabricated AFOs, and more. Q: I know Medicare provides a list of deleted L-Codes for the upcoming year. Do you know which L-Codes are no longer valid? Is there a website you can refer me to that lists these codes? I am trying to avoid any denials if possible. A: The following L-Codes are no longer valid, effective for dates of service beginning January 1, 2010, and have no replacement codes: L-0210, L-1800, L-1815, L-1825, L-1901, L-2770, L-3651, L-3652, L-3700, L-3701, L-3909, L-3911, and L-6639. You may go to www.cignagovernmentservices.com/jc/pubs/news/2009/1209/cope11134.html for a complete list of new and discontinued codes for 2010. Q: I am receiving denial messages from Medicare regarding my referring physicians and their provider information. I spoke to someone who told me I need to ensure my referring physicians are listed correctly on the PECOS system if I want my claims to be paid. Do you know what this is? Is Medicare saying the referring physician is not a Medicare provider? Any clarification would be greatly appreciated. We cannot afford to have our cash flow disrupted again for another reason. A: The Provider Enrollment, Chain, and Ownership System (PECOS) maintains enrollment information for physicians and non-physician practitioners except durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers. When you submit your claim to your Durable Medical Equipment Regional Carrier (DMERC), if the referring physician is not listed on the PECOS system correctly, your claim will be rejected effective April 5, 2010. PECOS only maintains information if the provider (referring physician) either enrolled or updated his or her information since November 2003. To find out more regarding this and how you can verify if the referring physician is listed on the PECOS System, visit www.cms.hhs.gov/medicareprovidersupenroll . The change request for this policy, CR 6421, is also available on the CMS website at www.cms.hhs.gov/transmittals/downloads/r480otn.pdf Q: I am a new billing manager in an O&P office in Region C. The practitioner and I are in disagreement as to which L-Codes are considered prefabricated and not custom fabricated. Can you please tell me all the L-Codes associated with a custom-fabricated ankle-foot orthosis? I feel they may have been billing incorrectly for certain items and want to clarify this. A: Codes L-1900, L-1904, L-1907, L-1920, L-1940-L-1950, L-1960-L-1970, L-1980-L-2030, L-2034, L-2036-L-2108, and L-2126-L-2128 describe custom-fabricated orthoses. These codes cannot be used to describe a prefabricated orthosis. Q: We provided a Medicare patient with a static AFO (L-4396) in June 2009. We billed Medicare for a replacement interface L-4392 in October 2009, and our claim was denied as CO-57. I thought a patient was allowed to receive replacement interfaces. Did Medicare change its guidelines? A: An L-4392 is covered as long as the patient continues to meet the coverage rules for the splint, and the coverage is limited to a maximum of one replacement interface per six months. 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 linkEmail('lisa','opedge.com'); or visit www.acc-q-data.com

Got FAQs?

ISPO and ORTHOPÄDIE + REHA-TECHNIK Combine

BOC Elects Chairwoman and Four Officers

BOC Elects Chairwoman and Four Officers

Get unlimited access!

O&P JOBS

CPO and Technician

CPO, CO, or Certified Assistant

Looking to make a move to Canada?

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

The most important industry news and events delivered directly to your inbox every week.

Welcome Back!

Retrieve your password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Got FAQs?

Support authors and subscribe to content

Subscribe

Related posts:

ISPO and ORTHOPÄDIE + REHA-TECHNIK Combine

BOC Elects Chairwoman and Four Officers

BOC Elects Chairwoman and Four Officers

Get unlimited access!

O&P JOBS

CPO and Technician

CPO, CO, or Certified Assistant

Looking to make a move to Canada?

Login to your account

Reset Password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Account Activation

The most important industry news and events delivered directly to your inbox every week.

Welcome Back!

Retrieve your password

Login to your account

Reset Password

Are you sure want to unlock this post?

Are you sure want to cancel subscription?

Account Activation