Billing and Collections Q&A

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By Lisa Lake-Salmon

Running an O&P practice is complicated enough without having to deal with denials. When you have questions, count on "Got FAQs?" to help keep your claims on track. This month's column tackles your questions about addition codes, licensing requirements, K-Codes, and more.


Q: I remember reading in a previous issue that there is an addition code for a foot when making a lower-limb prosthesis specifically for a patient over 300 lb. Can you tell me what the code is? We have a patient we are fitting with a limb that falls into this category.

A: Effective January 1, 2009, L-5993 (Addition to lower-extremity prosthesis, heavy duty feature, foot only, for patients whose weight is greater than 300 lb.) is no longer a valid code. There is no replacement code at this time. L-5994 (Addition to lower-extremity prosthesis, heavy-duty feature, knee only, for patients whose weight is greater than 300 lb.) and L-5995 (Addition to lower-extremity prosthesis, heavy-duty feature, other than foot or knee, for patients whose weight is greater than 300 lb.) have also been discontinued.

Q: I am a new provider in Region A and was wondering if there are any free websites I can use to check if the L-Codes and diagnosis codes I am using are valid. I was told I can purchase books about this, but I would prefer to use something that is free.

A: There are a number of websites you can use that will not cost you anything. To check if your Healthcare Common Procedure Coding System (HCPCS) code is still valid, visit www.dmepdac.com/dmecsapp/do/search or www.cms.hhs.gov/ hcpcsreleasecodesets/anhcpcs/list.asp . For a free Internet search for diagnosis codes, visit icd9cm.chrisendres.com/icd9cm/

Q: I am opening a new practice in Florida within the next six months, and I am unsure of the licensing requirements for that state. Do you know who I can contact for information on this? Do I need to get a sales-tax permit in this state? Any help you can provide would be greatly appreciated.

A: Sales-tax permits are not required for O&P practices in the state of Florida. For information on licensing, contact the Florida Board of Orthotists & Prosthetists, Florida Department of Health, at 850.245.4355. To find licensing requirements for any state, visit palmettogba.com/palmetto/statelicensure.nsf

Q: Our office has had numerous disputes regarding the use of the K modifiers on lower-limb prosthesis claims to Medicare. We were under the impression that this modifier is required on all lower-extremity codes. Can you please clarify whether we need the K0-K4 modifier on all the L-Codes when we bill for lower-limb prostheses?

A: According to Medicare guidelines, the K modifiers/functional classification were specifically to identify appropriate "functional" components such as knees, feet, and ankles. All other components are non-functional or structural in nature and are common to all lower-extremity prostheses; thus a functional classification is unnecessary. The billed code for knee, feet, and ankle components (HCPCS codes L-5610-L-5616, L-5710-L-5780, L-5810-L-5840, L-5848, L-5856, L-5857, L-5858, L-5930, L5970-L5987) must be submitted with modifiers K0-K4, indicating the expected patient functional level.

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. For more information, contact