Wednesday, May 25, 2022

Switching out foot after claim billed???

Tracy Fields

Good afternoon everyone. I am looking for experience and guidance.

We recently provided a prosthetic patient with a multiaxial rotation unit
(MCP or equal) L5986 and due to justifiable reasons we are wanting to
switch him out to a multiaxial ankle w/swing phase active dorsiflexion
feature L5968. My questions are….

1.) How am I able to do this billing wise if the claim has already been
billed and paid for the on the L5986?? The patient is covered by Medicaid.


2.) Do any of you have experience with this code L5968?? We have not billed
this one before. I researched the LCD guidelines and there is no mention of
it but when I google the information I see a proposed draft where they
mentioned K3 or higher but a rep stated it could be justified on a high K2.

Greatly appreciate any assistance you can provide.

Thank you

*Tracy Fields*
Billing Specialist

First Step Prosthetics

1136 US 31W Bypass, Bowling Green, KY 42101
Phone 270.904.6130 / Fax 270.721.0749
Email: [email protected]

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