Billing and Collections Q&A

Billing for O&P devices and care is complicated. When you have questions, count on "Got FAQs?" to help keep your claims on track. This month's column answers your questions about orthosis repair, new L-Codes for OTS orthoses, and billing regulations regarding powered base items. Q: My husband and I recently opened an O&P patient care facility, and I am trying to assist him with submitting Medicare claims. Have any new codes for off-the-shelf (OTS) orthoses been added in the last month? Also, if we provide an orthosis to a patient and we need to repair the device, are we allowed to bill for our time to fix it? A: Let's address each question separately. Effective October 1, there are two new codes for prefabricated OTS knee orthoses (KOs): K-0901 (KO, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, OTS); and K-0902 (KO, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, OTS). For additional information, visit www.oandp.com/link/280 In response to your second question, if you provide a patient with an orthosis, you may only bill for your time to repair the brace using L-4205 (repair of an orthotic device, labor component, per 15 minutes) if more than 90 days have passed since delivery. To review a recent article on this topic, "Coding for Professional Services," visit www.oandp.com/link/281 Q: I work for practitioners who are located in Georgia. We recently received a denial from Medicare stating that the payment for the item billed was included in the powered base item. I called Medicare and was told that I could not bill for any additional batteries or battery chargers when providing L-5781 (addition to lower-limb prosthesis, vacuum pump residual limb volume management and moisture evacuation system) or L-5782 (addition to lower-limb prosthesis, vacuum pump residual limb volume management and moisture evacuation system, heavy duty). If we provided this to the patient, why can't we receive reimbursement? Where can I find this information so I can explain it to my boss? A: Codes L-5781 and L-5782 are considered powered base items. Powered base items are L-Codes that contain a power source. When billing any of these base codes, all necessary batteries and battery chargers are considered included in the payment for the powered base code. No separate payment will be issued for batteries, which can be coded as L-7360 (six volt bat otto bock/eq ea); L-7364 (12 volt battery utah/equ); L-7367 (replacement lithium ionbatter); or L-8505 (artificial larynx, accessory). Further, no separate payment will be issued for the battery charger, which can be coded as L-7362 (battery chrgr six volt otto); L-7366 (battery chrgr 12 volt utah/e); or L-7368 (lithium ion battery charger). For a complete list of all base codes with a battery charger and/or power included, see pg. 15-17 of The DME MAC (Durable Medical Equipment Medicare Administrative Contractor) Jurisdiction C INSIDER, Edition 28, Summer 2014, at www.oandp.com/link/282 Lisa Lake-Salmon is the 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 lisa@opedge.com or visit www.acc-q-data.com

Billing and Collections Q&A

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