Got FAQs?

Running an O&P practice gets more complicated every year. When billing questions or denials have you at your wits' end, count on "Got FAQs?" to help restore your sanity and keep your accounts receivables on track. This month's column addresses your questions about the "two-day rule," L-Code descriptions, and custom-shoe inserts. Q: Where can I find information regarding the "two-day rule" that states when it is appropriate for an O&P facility to bill Medicare versus the rehabilitation center having to pay for an item directly? We have a situation where we delivered a CROW boot on Wednesday, and the patient was scheduled for discharge on Friday; however, the patient did not get discharged until the following Monday. I would like to better understand the ruling so I may go back to the rehabilitation center for appropriate payment. A: Since you are located in Region C (Florida), I referred to the Region C Supplier Manual and reviewed the documentation on coverage for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and an inpatient stay, which can be found in Chapter 6, Section 13, pages 25 and 26 ( www.cignagovernmentservices.com/jc/pubs/pdf/chpt6.pdf ). One of the conditions listed that must be met is that "the supplier delivers the item to the beneficiary no earlier than two days before the day the facility discharges the beneficiary." The general rule is that the date of service is equal to the date of delivery. However, pre-discharge delivery of items intended for use upon discharge is considered provided on the date of discharge. In this case, the date of service on the claim should be the date of discharge. Q: You recently replied to a question in The O&P EDGE , and the L-Code description you gave was very detailed. Where can I find a list of L-Codes with long descriptions, rather than the short ones I have viewed on the Medicare Region D website? A: For a detailed description of an L-Code, I usually refer to the following PDF file: www.cignagovernmentservices.com/jc/pubs/pdf/appa.pdf. The local coverage determination (LCD) section provides detailed descriptions for each L-Code. For example, if you need to look up the description of L-1970, you would go to the LCD section for AFOs, which can be found at www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=11517&lcd_version=46&show=all . Please let me know if you find these sites useful. Q: If I bill for bilateral custom shoes (2X) A-5501, can I bill for the custom inserts as (2X) A-5513, or are they included in the A-5501 code? For example, I am billing the shoes with toe filler as (2X) A-5501 and L-5000 (1X). Would I bill for the A-5513 on the other side? A: When you are billing Medicare for patients who meet the coverage criteria for bilateral custom shoes, you would bill A-5501 RT LT KX 2 units (pair). The A-5501 (one pair of custom-molded shoes) includes a pair of inserts (A-5513 RT LT KX). You may provide two additional pairs of inserts (A-5513 RT LT KX 2 units, pair) to the patient per year. You would bill the L-5000 (partial foot, shoe insert with longitudinal arch, toe filler) either RT or LT and the KX modifier. 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 linkEmail('lisa','opedge.com'); or visit www.acc-q-data.com

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ACA Names Development Director

Otto Bock Promotes Anderson

Otto Bock Promotes Anderson

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Certified Orthotist & Orthotic Technician

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