In a joint publication, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) and the Pricing, Data Analysis and Coding (PDAC) contractor released a bulletin about correct coding information for upper-limb prosthetic devices. The reminder was necessary “based on recent analysis of claims,” according to the publication.
Correct coding is a determination that the item provided to a beneficiary is billed using the appropriate Healthcare Common Procedure Coding System (HCPCS) code for that item. Upper-limb prostheses are generally categorized and described by the level of amputation and the type of power source utilized to operate the device. There are three types of upper-limb prostheses that reference the power source:
- Body-power prostheses rely on a system of mechanisms such as cable(s), linkage(s), or anchor point(s) and upon the coordination of contracting muscles create motion of the prosthetic limb’s joints via the control mechanism.
- External-power (i.e., electrical) prostheses are controlled by the use of electric signals from the body’s muscles that are translated and amplified via battery power to eventual control of the prosthetic components.
- Passive/restorative prostheses do not have active motion within the prosthesis. Passive prostheses may allow motion of the next proximal joint without controlling a motion within the prosthesis. Motion of the passive prosthesis is not described as external or body power.
“Correct coding of an upper-extremity prosthetic limb is based on the amputation level, using appropriate code(s) that are limited based on the level of amputation described in the code narrative. Upper-extremity codes without a limb amputation level may be appropriate when it conforms to the coding guideline for that specific code,” the publication said.
To read the announcement, visit “Upper Limb Prostheses – Correct Coding.”