Billing and Collections Q&A

Dealing with denials is time-consuming and complicated. Count on "Got FAQs?" to help keep your claims on track. This month's column tackles your questions about repair codes, electronic funds transfer, authorization codes, and more. Q: I am an office manager for a P&O practice in Region C. Every time we do a repair on an orthosis, my practitioners code each claim as L-4210. Is this correct? Should every repair be coded with this code and the description? Please help. I do not want to have a problem if Medicare audits us. A: It is improper to use L-4210 (repair of orthotic device, repair or replace minor parts) for a repair if what is actually performed is a replacement of an item that is described by another Healthcare Common Procedure Coding System (HCPCS) code. For example, replacing a strap would be coded as L-4002 (replacement strap, any orthosis, includes all components, any length, any type), and not L-4210. Using an improper code regularly may send a signal to Medicare that you are trying to obtain higher reimbursements, and it could be viewed as abusive. For a listing of all repair/replacement codes, see www.cignagovernmentservices.com/jc/pubs/pdf/appa.pdf . The listing of codes is on pages 159 and 160. Q: We are a provider in a rural area and have recently experienced numerous delays in receiving our checks from some insurance companies. Do you know if we can receive direct deposit from Blue Cross Blue Shield (BCBS) of North Carolina and North Carolina Medicaid? If it is possible, whom should I contact? A: Both BCBS and Medicaid offer direct-deposit electronic funds transfer (EFT). For North Carolina Medicaid, the form you need to fill out is available at www.dhhs.state.nc.us/dma/forms/eft.pdf . For BCBS, the form is available at www.bcbsnc.com/providers/edi/pdfs/eftrequest-form.pdf Q: We received a denial for North Carolina Medicaid for no authorization for codes L-3010 and L-3020. We have never before needed an authorization for these codes. The patients are under 21 years old. Do you know if Medicaid changed its requirements? I have tried searching its website and cannot find anything. A: There are codes that require a prior authorization (PA), regardless of the patient's age. There are also codes that require a PA for patients only if they are 21 years of age or older. According to the North Carolina Medicaid provider manual, L-3010 and L-3020 do not require authorization for patients under 21. Therefore, I would contact Medicaid and inform them that your claim was denied incorrectly and needs to be paid. The documentation that supports this is on page 105 of the Medicare provider manual: www.dhhs.state.nc.us/dma/basicmed/apr08/05submittingclaims.pdf Q: We are a new company, and we just received our first bilateral amputee referral. However, the physician used 457.1 as the diagnosis code. Could you tell me the correct diagnosis code for a bilateral transtibial amputee? A: The correct DX code to use for a bilateral transtibial amputation is 897.6 (traumatic amputation of leg(s) complete or partial bilateral of any level without mention of complication). You can also use 897.7 (traumatic amputation of leg(s) complete or partial bilateral of any level with mention of complication). 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. This Q&A is provided as a service to our readers. While every attempt has been made to ensure accuracy, The O&P EDGE is not responsible for errors. For more information, contact lisa@opedge.com

Billing and Collections Q&A

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CMS: Have Licensure or Post $50K Bond

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