The medical review department at Noridian, the Jurisdiction A Durable Medical Equipment Medicare Administrative Contractor (DME MAC), released quarterly results of its post-payment service-specific review of knee orthosis codes.
The reviews, conducted in June through August, included Healthcare Common Procedure Coding System (HCPCS) codes L-1833 (knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf) and L-1851 (knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf).
Based on dollars, the overall claim potential improper payment rate was 75 percent for L-1833 and 89 percent for L-1851.
The top denial reasons were:
- Documentation was not received in response to the post-payment notification letter.
- Documentation did not support coverage criteria.
- No medical record documentation was received.
- Medical record documentation was not authenticated (handwritten or electronic) by the author.