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Denials are difficult to identify and time consuming to appeal. With competitive bidding, mandatory accreditation, aging technology, and increased billing erros, running an O&P show gets more complicated each year.

Q: I have a question regarding the use of patient digital photographs for the sole purpose of fabricating either an orthosis or a transtibial prosthetic socket. Do Health Insurance Portability and Accountability Act (HIPAA) guidelines require a special waiver or a specific agreement between the patient and the O&P facility for such use?

A: HIPAA requires you to provide your patient with a copy of your privacy practices and receive a signed receipt from your patient acknowledging he or she was advised of the same. Section C under your privacy agreement should cover the use of the patient's patient health information (PHI) for treatment purposes.

Q: I have called Medicare numerous times and I still cannot come up with an answer for this. I have a patient who is a transtibial amputee, and he just used his Medicare benefits to receive an electric wheelchair. He now wants a new prosthesis. I was under the impression Medicare would not pay for both. Will they?

A: In order for Medicare to pay for the patients electric wheelchair, there would have been enough medical documentation stating the patient was unable to ambulate without the use of this chair. By providing a prosthesis, you are stating the patient would be able to ambulate with this device, which would conflict with why the patient needed a power wheelchair. Medicare will not pay for both.

Q: I recently received a denial for L-1855 from Blue Cross Blue Shield (BCBS) of Colorado and was told this was no longer a valid code. I cannot seem to find what code replaced this, if any. Are you aware of a code change for this?

A: Effective January 1, 2008, L-1855is no longer a valid code. According to the Level II Healthcare Common Procedure Coding System (HCPCS) for 2008, this code has been changed to L-1846 (knee orthosis, molded plastic, thigh and calf sections, with double upright knee joints, custom fabricated).

Q: I billed Medicare in the past for L-3845 (wrist-hand-finger orthosis [WHFO], addition to short/long components) and always received payment for this in addition to the WHFO. I recently noticed that we have not been reimbursed for the addition, only the orthosis. Has something changed pertaining to these codes that I am not aware of?

A: Surprise! As of January 1, 2008, Medicare considers this not separately payable. The addition is included in the allowance for the orthosis base code.

Lisa Lake-Salmon is the executive vice president of ACC-Q-Data, which provides billing, collections, and practice management software and 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. For more information, contact lisa@opedge.com

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