Billing and Collections Q&#038;A

When you need help with your toughest billing questions, count on Got FAQs? to provide you with the information you need to help keep your billing on track. This month's column tackles your questions about AFO medical necessity requirements, diagnosis codes, and conditions to be met; and proof of delivery documentation. Q: We recently opened a facility in Alabama. What are the medical necessity requirements for providing AFOs, and the diagnosis codes and conditions that must be met? Where can I find information about the necessary documentation to keep in our file? On another note, can you provide a documentation checklist for diabetic shoes? Your help is greatly appreciated. A: According to the Medicare Region C Local Coverage Determination (LCD), AFOs may be covered for patients who are ambulatory and have weakness and/ or deformity of the foot, require stabilization for medical reasons, and have the potential to benefit functionally. These AFOs are billed with L-1900; L-1902 through L-1990; L-2106 through L-2116; L-4350; L-4360; L-4386; L-4387; and L-4631. The only AFOs covered for nonambulatory patients are those described by L-4396 (static AFO) or L-4397 (static or dynamic AFO pre-OTS). Coverage requirements include a documented diagnosis of plantarflexion contracture (718.47) with passive range of motion testing of at least 10 degrees dorsiflexion, a reasonable expectation of the ability to correct the contracture with the AFO, the contracture is interfering significantly with the beneficiary's functional abilities, and the brace is used as part of a therapy program that includes active stretching of the muscles and tendons; or the beneficiary has a documented diagnosis of plantar fasciitis (728.71). Always verify the manufacturer, product, and L-Code to ensure a written coding verification has been made by the Medicare Pricing, Data Analysis, and Coding (PDAC) contractor and that the item is listed on www.dmepdac.com (search for "Items Requiring Coding Verification Reviews"). To read the LCD for AFOs, visit www.oandp.com/link/310 . To access the documentation checklist for therapeutic shoes, visit www.oandp.com/link/311 . Q: I recently attended a workshop where I was informed that proof of delivery (POD) documentation must include specific information in order for us to be paid. I am not sure what information I need. I searched the Medicare website and was unable to find anything new on this. A: On February 12, Medicare issued a reminder stating that suppliers have a misunderstanding about the purpose of POD. POD is a supplier standard, and suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) are required to maintain POD documentation in their files. For medical review purposes, POD serves to assist in determining correct coding and billing information for claims submitted for Medicare reimbursement. One of the requirements for proper POD documentation is a sufficiently detailed description to identify the item(s) being delivered (e.g., brand name, serial number, narrative description). Reviewers often see a reiteration of the Healthcare Common Procedure Coding System (HCPCS) code narrative on the POD form as the detailed description of the item, particularly for orthotics and prosthetics. This is not adequate for POD purposes. The preferred method is use of a brand name and model number, brand name and serial number, or manufacturer name and part number to identify the product. If this type of information is not available for the product, suppliers may use a detailed narrative description of the item; however, it must contain sufficient descriptive information to allow a proper coding determination. This narrative description of the item is not the HCPCS code narrative. POD documents that fail to properly identify DMEPOS products to allow reviewers to make a correct coding determination will be denied for insufficient delivery information. To read the article, visit www.oandp.com/link/312 . 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 .

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