March 2006 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: I received a front-end denial for L-3963 stating procedure code or modifier invalid for date of service and do not understand why this would be denied since I have billed in the past and was paid for this code.
A: Your claim was denied because as of January 1, 2006, procedure code L-3963 (shoulder elbow wrist hand orthosis, molded with articulating elbow joint custom fabricated) was deleted and replaced with either L-3971 or L-3973.
Q: I am a provider located in Region B, and I recently heard the codes for compression stockings have changed. Is this true? If so, what are the new codes, and when did this change become effective?
A: Yes, it is true that effective January 1, 2006, the changes for compression stockings are as follows:
L-8100 (new code A-6530), L-8110 (A-6531), L8120 (A-6532), L-8130 (A-6533), L-8140 (A-6534), L-8150 (A-6535), L-8160 (A-6536), L-8170 (A-6537), L-8180 (A-6538), L-8190 (A-6539), L-8195 (A-6540), L-8200 (A-6541), L-8210 (A-6542), L-8220 (A-6543), L-8230 (A-6544), L-8239 (A-6549).
Q: I was informed by the manufacturer to bill for K-0618 and K-0619 for services I provided, and received a denial (CO-16) from Medicare. I am a new O&P provider, and I do not understand why my claim would be denied.
A: You stated you received a CO-16 (claims lacks information). If your date of service is after January 1, 2006, your claim was denied for CO-16 because these codes are no longer valid and were replaced as follows: K-0618 was changed to L-0491; and K-0619 was changed to L-0492.
We invite readers to ask questions you have regarding billing,
collections, or any other information. To send your questions or
for more information, contact: firstname.lastname@example.org
Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for more than a decade. For more information contact email@example.com
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data, Inc.