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
Q: As an O&P provider, I receive many
requests to deliver items to a patient while they are in the
hospital and I find I have a hard time being paid for these
services by Medicare. Please advise me how to properly bill
Medicare for these services.
A: According to DMEPOS, you may deliver items
to a patient during an inpatient stay at a hospital as long as the
delivery date is within two days prior to discharge and the item is
needed for fitting and training purposes. When billing Medicare,
your date of service should be the patient’s discharge date instead
of date of delivery. Your place of service should either be 11
(office) or 12 (home). You should have all the proper documentation
in the patient file to support this information.
Q: I have recently received multiple denials
from Medicare due to diagnosis codes not being valid. Can you
please help me understand this, since the codes are listed in the
current ICD-9 code books?
A: Effective April 1, 2003, the DMERCS have
implemented new edits related to diagnosis codes.
ICD-9 codes contain three, four, or five digits. If a code which
you may have used in the past has either a fourth or fifth digit
which further describes the diagnosis, then the three-digit code
will be denied. Your claim must be resubmitted with the proper
fourth or fifth digit in order for your claim to be paid.
We encourage readers to write in and ask any questions you
have regarding billing, collections, or any other related
Acc-Q-Data provides billing, collections and practice
management software serving the O&P industry nationwide for
over a decade. To send your questions or for information,
Lisa Lake-Salmon is Executive Vice President, Acc-Q-Data Inc.