December 2003 Issue
The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.
Q: A patient came into my office with a prescription for a Cam Walker. The patient had already received an AFO brace in the beginning of the year. Will Medicare now pay for the Cam Walker, and if so, how should I bill? Please help, as I can not afford to keep giving products away for free.
A:Medicare will not cover a Cam Walker, since the patient already received an AFO brace in the same calendar year. If you give the patient a Cam Walker, you must have the patient sign an ABN (Advance Beneficiary Notice) form, informing the patient that Medicare will not cover this item and the cost would be his or her responsibility. You need to bill using the GA modifier, letting Medicare know that you have a signed ABN on file. This will then allow you to bill the patient once Medicare denies.
Q: I have recently received a denial using a procedure code of L-5621. I have been using this code for the last few years and have always been paid. Please help; I am very confused.
A: More than likely, the reason you have received this denial is that L-5621 is no longer a valid code. It was replaced with L-5620 (addition to lower extremity, test socket below knee). There are numerous ways to verify if a code is valid. One of them would be to contact SADMERC at 877.735.1326; SADMERC is a division of Medicare.
We invite readers to ask any questions you have regarding billing, collections, or any other information. To send your questions or for more information, contact: firstname.lastname@example.org.