Friday, April 12, 2024

Diagnosis coding vs. design type

Dave Hewett

I have an extremely short Trans Tib. Unfortunately, he was not successful
in a TT prosthesis and decided a trans femoral design was a better
functional design for his needs.

My question is what is the experience in this situation billing Medicare
when the amputation level (TT) is different than the L code design (Trans
femoral) from a claim submission point of view?

We have excellent documentation from the MD for the design. I’m just
inquiring if I should expect a automatic denial and plan to fight this one.

Thanks,
Dave


David Hewett, CP, ATP, BOCPO
ADAPTIVE PROSTHETICS & ORTHOTICS, llc
52 National Dr, Glastonbury, CT 06033
860-633-7298

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