Update: L-5845 Audit Issue Removed from Performant Website
May 01, 2017
Performant Recovery, the Region 5 national Recovery Audit Contractor (RAC) for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and home health/hospice services, announced it will begin audit activities on L-5845 (addition, endoskeletal knee-shin system, stance flexion feature, adjustable) with incompatible codes. Claims with claim paid dates that are more than three years prior to the demand letter date will be excluded.
According to the announcement (issue number 0049, dated April 12), this audit recoups overpayments made to DMEPOS suppliers billing L-5845 with endoskeletal items with which it is not compatible. The announcement states the following:
The use of L-5845 describes a prosthetic knee (predication-ESK PSPC Endolite-Stance flexion plate w/rubber) that allows a single-axis knee to stand in flexion during the dynamic gait cycle with an adjustable knee flexion feature. The adjustable flexion feature component is independent of the friction/fluid screw adjustment system provided within the knee unit. The stance flexion feature is an "active adjustable control" during gait and is not a static trochanter-knee-ankle (TKA) alignment. The stance flexion feature provides adjustable stance control in flexion during the dynamic gait cycle (independent of the friction/fluid adjustment systems provided within the knee unit). The stance flexion feature is an addition to a prosthetic knee with active "adjustable" control. This addition code is not static alignment using TKA. The base codes for specific knee units L-5610, L-5613, L-5616, L-5810 through L-5812, L-5814 through L-5816, L-5818, L-5822, and L-5826 do not provide same or similar functionality of active adjustable control of stance flexion and L-5845 is, therefore, incompatible with these codes.