Q: I read in a previous issue of The O&P EDGE that Medicare no longer pays separately for L-3845 and was wondering if there are other L-Codes in the WHFO (wrist-hand-foot orthosis) category for which it will not pay separately? A: Effective January 1, 2008, the following codes are no longer paid for separately, and are included in the allowance for the orthosis base code: L-3810, L-3815, L-3820, L-3825, L-3830, L-3835, L-3840, L-3845, L-3850, L-3855, and L-3860. Q: I am a billing manager for an O&P practice. I recently read about a new code for replacement interface material and now I cant find it anywhere on the DMERC website. Are you familiar with this? Do you know what the new code is? Does it replace another code? Any help would be greatly appreciated. A: Effective April 1, 2008, a new K-Code was establishedK-0672 (addition to lower-extremity orthosis, removable soft interface, all components, replacement only, each). You may find more information regarding this at www.cms.hhs.gov/Transmittals/downloads/R1441CP.pdf Q: My Medicare enrollment package was returned to me, stating it was incomplete. I was told I needed an NPI number before my application can be processed. Can you tell me where I can go to apply for one? I did not realize I needed this before I sent in my enrollment application. A: Medicare will not issue a new provider number unless you have already received your NPI number. You may apply for an NPI number online at http://nppes.cms.hhs.gov. If you have any questions regarding your NPI number you may also contact the National Provider Enumerator Customer Service at 800.465.3203. Q: I recently graduated, and this is the first preparatory BK (L-5510) for which I am billing. Are there any L-Codes for the additions I cant bill for? I do not want my first Medicare claim denied; I have to pay the manufacturers for the materials. I just want to make sure all the codes I am billing for are correct. A: Welcome to the world of O&P. When billing Medicare for an initial BK prosthesis (L-5500) or a preparatory BK prosthesis (L-5510, L-5540), the following codes, if billed in conjunction with the above-mentioned base code, will deny as not medically necessary: L-5629, L-5638, L-5639, L-5646, L-5647, L-5704, L-5785, L-5-962, and L-5980. Remember to bill with a RT or LT modifier and a K modifier for the patients functional level. Lisa Lake-Salmon is the executive vice president of ACC-Q-Data, which provides billing, collections, and practice management software and 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 lisa@opedge.com
