By Lisa Lake-Salmon
Executive Vice President
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: I provided a knee brace to a patient ten months ago, and now the patient says it does not fit properly, so he would like to return it. Am I required to take the brace back from the patient after ten months? Medicare paid for this brace.
A: Since the patient has had the brace for ten months, you are not required to take it back. If you let the patient return the brace, Medicare can request a refund on the monies paid to you.
Q: I have a patient who has plantar fasciitis and requires a night splint. Is this type of orthotic covered by Medicare, and do you know what code I would use to bill?
A: A night splint is covered under the AFO policy as a static ankle-foot orthosis. The HCPCS code is L-4396. Please note the ICD-9 code for plantar fasciitis is 728.71.
Q: I heard that Medicare will now reimburse for compression stockings. Can you let me know if this is true?
A: Effective Oct 1, 2003, Medicare began reimbursing for L-8110 (gradient compression stocking below knee, 30-40 mmHg) and L-8120 (compression stocking, 40-50 mmHg). This may be covered under the surgical dressing benefit when it is used to secure a primary dressing over an open wound or venous stasis ulcer that has debridement, and when the gradient stocking can be proven to deliver compression greater then 30 mmHg and less then 50 mmHg. You must use either the RT or LT modifier along with the AW modifier.
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: lisa@
Acc-Q-Data provides billing, collections and practice management
software serving the O&P industry nationwide for over a