Last Friday I asked about the purpose of K codes, particularly two that were brought to my attention: K-0901 & K-0902. Here are the responses. My thanks to those who responded.
David, Thank you for sharing your file…. In regards to the K code, the general consensus in the field is that these K codes will eventually be part of the competitive bidding sector. What we found is that there are several codes with identical coding except one states “custom fitted” and the other is a straight OTS code that requires no adjustments. If using the “custom fitted” code, by policy, we are required to have the MD notes specifically state that the brace may need custom fitted and we are also required to explain in our notes exactly how we custom fit the brace in a way that only a trained specialist could do it (versus the patient). The kicker is the reimbursement is exactly the same for both the custom fitted code and the OTS (not custom fitted code). And the OTS equivalent requires NONE of these added measures. So, why would anyone bill for the custom fitted code? It only sets you up for added risk of audit, your admin staff has to assure the MD has documented the need for custom fit and you need to assure that your practitioners have adequately stated that they used a heat gun or bending irons or some other tool inaccessible to the average patient. That’s a lot more work for the exact same allowable. I have my practitioners use the OTS codes ALWAYS if one is available for the same item. The Kcodes are just the OTS (i.e. not custom fitted) version of the Lcodes 1843 and 1845.
Joan K. Cestaro, C.P.
They are DME medical equipment and supply codes. Standard DME equipment and supply codes are either E or K codes.
David Hendricks, CPO
Blue Diamond Orthopedic
6439 Milner Blvd
Orlando, FL 32809