After inconsistent and unclear Medicare audits of some of our claims for custom-fitted LSO codes L-0637 and L-0650, I think it’s time to develop objective standards for consistency in O&P billing and auditing.
When we asked the auditor the reason for the denials and why some with similar information were approved, the response was only that we needed to read the requirements for that specific orthosis. We later spoke with someone who essentially just read the posted requirements. I asked for examples of what would be considered a custom fit and was offered a case for someone with a colostomy bag. I asked about hyperlordosis or a significant pendulous abdomen, and was told that a regular person should be able to make modifications for those problems. I pointed out that the Kydex insert needs to be heated to at least 320 degrees to begin bending it.