<img style="float: right;" src="https://opedge.com/Content/OldArticles/images/2003-11_07/lisa_lakesalmon.jpg" hspace="4" vspace="4" /> 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. <b><i>Q: I saw your article in The O&P EDGE. I have been getting denied by Medicare left and rightand not only for diabetic shoes. Knee braces are also a big denial item. I am using diagnosis 715.9 for osteoarthritis&they will deny as the day is long. Should I use DJD? I am desperate and frustrated. It isnt funny&HELP!</i></b> <b><i>A:</i></b>The reason you are receiving these denials is due to your diagnosis not going to the fifth digit. It is safe to presume that the patient has osteoarthritis of the knee or lower limb. Therefore, in this case the proper diagnosis would be 715.96: osteoarthritis of the lower leg. <b><i>Q: I have previously experienced a few patients that came to us wanting a new prosthesis because the one they received from their previous provider was ill-fitting or not working for them. What guidelines or protocol should we follow when consulting the patient on manufacturing a new leg for them?</i></b> <i><b>A:</b></i> Medicare has a certain time limit on how often a patient can receive a new leg. You would first need to obtain records from the previous provider showing that either the patient and/or provider made several attempts to rectify the problems with the prosthesis. These records could include, for example, progress notes showing adjustments and corrections that were made, any replacements of components, and medical records relating to the patients problem area. Then, you will need to have the patient sign an Assignment of Benefits (AOB), which advises him/her that if for any reason Medicare should deny the claim, he/she might be responsible. I would advise that you send this claim hardcopy with all additional documentation and medical notes. <i>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:</i><a href="mailto:lisa@westernmediallc.com"><i>lisa@westernmediallc.com</i></a> <i>Acc-Q-Data provides billing, collections, and practice management software serving the O&P industry nationwide for over a decade.</i>
