The future of your practice depends on knowledgeable billing and collection information. Understanding the full aspect of billing guidelines and procedures will effectively increase your reimbursement. This informative column will help providers and their staff with a better understanding of billing procedures and reimbursement strategies.
Q: I am a new O&P provider, and I am not certain
as to what documentation is required to provide a patient with an
AFO or KAFO.
A:You must have a signed prescription
on file that states the features of the base HCPCS code and all
additions that will be billed on a separate line. Please note when
billing for either L4396 or L4392 that your prescription must
include the patient’s diagnosis.
Q: I billed for the first time a breast prosthesis
to Medicare and my claim was denied for CO-16. I contacted Medicare
and I was told my claim was missing the appropriate modifier. Which
modifier do I use?
A: When billing for a breast
prosthesis, you must use either the RT (right) or LT (left)
If the patient had a bilateral mastectomy, you must use both
modifiers on one line item and your number of units should be
We invite readers to ask any questions you have regarding
billing, collections, or any other related information. To send
your questions or for more information, contact:[email protected]
Acc-Q-Data provides billing, collections and practice
management software serving the O&P industry nationwide for
over a decade.
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.