L-Codes: Why We Use Them and Why I Share My File
June 2018 Issue
Someone once said, "In theory, there is no difference between theory and practice; in practice, there is." I learned years ago in Northwestern's P&O program that when you design a prosthesis or orthosis, you aspire to three things: weightlessness, invisibility, and insensibility. Over time, I learned that while those unachievable goals are good to bear in mind as you make the device as light as possible, as cosmetic as possible, and as comfortable as possible, my instructors had omitted one vital and achievable goal: It is mandatory that your product receive favorable reimbursement.
In theory, you should design the product for the patient and pay no mind to reimbursement. In practice, if you do that, the patient will never see the product, because the orthotist will never fit it, because the orthotic practice will never buy it, because they will never get paid for it.
Although I'm a CPO, I haven't practiced O&P or billed the Centers for Medicare & Medicaid Services (CMS) in years, so I shouldn't need to worry about L-Codes. As a designer of spinal braces—an orthopedic caregiver turned untrained engineer—why should I pay attention to L-Code reimbursement rates? This question reminds me of a recent discussion in the café where I eat breakfast. One of our number was missing, having been sentenced to five years of free—if not quite as tasty—breakfasts for not paying his taxes. A friend at the table asked, "Why didn't he pay?" I inverted the question. "Why do you pay?" He thought a moment, then said, "They have guns."
Now that we've established the necessity of L-Codes, how do you get them? While they are freely available, they are not provided by CMS in a user-friendly package. After finding the spreadsheet I needed within a CMS zip folder, I saw that it contained hundreds of rows and dozens of columns. Not wanting to plow through them all each time I needed to look up an L-Code, I downloaded, rearranged, and revised the file for my own use.
First, I eliminated all but L-Codes, deleted cells without useful information, added an average-allowable column (the average of CMS' floor and ceiling reimbursement rates, which is more useful in my work than to practitioners), inserted a long-description column, made the columns sortable, made the useful data easier to find, and added some color. Sometime later, a friend and brace manufacturer mentioned that he couldn't find the long description of an L-Code. "I have a file!" I said. He called later to say how much he loved the spreadsheet. "It's so easy to use," he said. "I bet O&P people would like it." For that reason, I offer it each year on Paul Prusakowski's OANDP-L listserv as a New Year's tradition.
The most current version is always available for download on my website, www.bluedortho.com. Under the Resources pull-down tab, click on Request PDAC L-Code File, and submit the brief form. Aside from general information, the form notes that the data in the spreadsheet comes from CMS and that I accept no liability for its use. I simply provide the reformatted information to be more useful for O&P providers. I'm extremely gratified to hear how much it's appreciated.
David Hendricks, CPO, president, Blue Diamond Orthopedic, Orlando, Florida, can be reached at firstname.lastname@example.org.