May 2010 Issue
Running an O&P practice gets more complex every year. When you have a question about claims or denials, count on 'Got FAQs?' to help keep your billing on track. This month's column covers your questions about replacement codes, RP and RA modifiers, and addition codes.
Q: Can you advise me on which code replaced L-2770? I know it is no longer a valid code. Do you know when it changed?
A: You are correct. Medicare no longer reimburses for L-2770 (addition to lower-extremity orthosis, any material - per bar or joint). It stopped being reimbursed in July 2008. There is no replacement code for L-2770. You may find information regarding this at www.cignagovernmentservices.com/jc/pubs/news/2009/1209/cope11266.html
Q: I have a question about the RP and RA modifier. If the replacement item is a mastectomy bra that has been replaced due to being lost at a facility, and an incident report will be included with the claim, would the bra be considered part of the prosthesis? Which modifier would we use? Is the RP modifier now completely invalid? Just to clarify, if a foot is replaced on a leg, we would use the RB modifier, correct?
A: For dates of service after January 1, 2009, the RA modifier should be used on durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) claims to indicate when an item is furnished as a replacement for the same item that has been lost, stolen, or irreparably damaged. For dates of service after January 1, 2009, the RB modifier should be used on DMEPOS claims to indicate replacement parts of an item (base equipment/device) furnished as part of the service of repairing the item (base equipment/device). You may find this information at www.cignagovernmentservices.com/jc/pubs/pdf/chpt5.pdf on pages 21 and 23.
Q: I have a patient who requires an L-1840. The patient weighs over 350 pounds and requires specific joint additions to the brace due to his/her weight. I was told there are specific codes for this and do not see this information anywhere on Medicare's website. Also, which DX codes are considered medically necessary for this brace?
A: The L-1840 (custom fabricated de-rotation knee orthosis) can be billed with addition codes L-2385 (addition to lower extremity, straight knee joint, heavy duty, each joint) and L-2395 (addition to lower extremity, offset knee joint, heavy duty, each joint). These codes are covered for patients who weigh over 300 pounds. To find out the ICD-9 codes that support medical necessity for L-1840, visit www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=22664&lcd_version=18&show=all
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