Billing and Collections Q&A

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By Lisa Lake-Salmon
Lisa Lake-Salmon

Denials are difficult to identify and time consuming to appeal. "Got FAQs?" is here to help answer your most pressing billing questions. This month's column addresses your questions about consignment closets, billing for CROW boots, modifiers to use when billing for replacement facial prostheses, and more.

Q: I am a practitioner who maintains consignment closets at several physician offices. I heard there will be some changes to this type of arrangement and was wondering if you have any information on this?

A: Effective March 1, 2010, Medicare-enrolled suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) may maintain inventory at a practice location owned by a physician or a non-physician practitioner for the purpose of DMEPOS distribution only when the DMEPOS supplier meets the following conditions as verified by the NSC: The title to the DMEPOS shall be transferred to the enrolled physician, non-physician practitioner practice at the time the DMEPOS is furnished to the beneficiary; the physician or non-physician practitioner shall bill for the DMEPOS supplies and services using his or her own enrolled DMEPOS billing number; all services provided to a Medicare beneficiary concerning fitting or use of the DMEPOS shall be performed by individuals being paid by the physician or non-physician practitioner's practice and not by any other DMEPOS supplier; and the beneficiary shall be advised that if he or she has a problem or question regarding the DMEPOS, then the beneficiary should contact the physician or non-physician practitioner and not the DMEPOS supplier who placed the DMEPOS at the physician or non-physician practitioner's practice. Visit www.cms.hhs.gov/transmittals/downloads/r300pi.pdf for more information on this policy change.

Q: We have several claims that were denied by Medicare for having incorrect modifiers. Do we have to send in an appeal for all of these claims to Region C in order for them to be paid? Is there a form letter you have for these appeals that you suggest we use?

A: If you have several claims that were denied due to an incorrect modifier, you must submit your reopening request by fax. In your fax request, you should include a reopening request form with the appropriate information to process your claim. You may find the reopening request form at www.cignagovernmentservices.com/jc/forms/index.html. Once you fill out all the necessary paperwork for each claim that was denied, fax your reopening request to 615.782.4649.

Q: I received a prescription for a CROW boot for a patient who has diabetes. We have never billed for this particular item. Can you tell me what codes are used to bill for this device?

A: The correct coding for a CROW boot, also known as a charcot restraint orthotic walker, is as follows: The base code is L-1960, and the addition codes are L-2232, L-2275, L-2340, L-2820, and L-3010.

Q: We billed Medicare for a replacement facial prosthesis using code L-8043, and A-4450 and A-5120 for adhesives. All of our codes were denied for missing correct modifiers. I cannot find anywhere the correct modifiers to use with these codes.

A: If the replacement prosthesis is fabricated starting with a new impression, the KM modifier would be used. When a replacement prosthesis is fabricated using a previous master model, the KN modifier would be used. When A-4450 and A-5120 are used with a facial prosthesis, they should be billed with the AV modifier.

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 or visit www.acc-q-data.com