Sunday, November 27, 2022

L Code to replace foot shell RESPONSES

Randy McFarland

ORIGINAL POST:

Hi Listmembers,
Any suggestions on what L code to use when replacing a foot shell for a
carbon prosthetic foot? Thanks, Randy McFarland, CPO Fullerton, CA

RESPONSES:

Am I lost in a time warp? What happened to the RP Modifier? Code the foot
with the modifier ( RP 5981, etc. + whatever else constitutes the foot) and
charge what you think the foot shell and doffing and donning the foot shell
( your labor) is worth.

My guess would be the sach replacement code. I will be interested to see
what other opinions are.

I use L7510 Repair/replace minor parts, prosthetic device, and you might as
well include manufacturer’s invoice, if you bill hard copy, or at least be
prepared to if you bill electronically. You can also include L7520, Repair
prosthetic device, 1/4 hourly rate,I believe, if significant time (labor) is
involved in the replacement procedure. Some of those foot shells are a pain
to get on and off, especially if you’ve glued a cover to them.

The proper way to code for a replacement foot shell is to use the prosthetic
repair/replacement code for parts L7510 and add the labor L7520. No codes
were ever issued for the replacement shell. A second option would be to use
the L2999 unlisted procedure code. In any event the best way to get paid is
collect up front.

L7510 Replacement Parts, Include the Invoice plus (we use) 30%, L7520 for
the labor.

L7510 -cost X1.5

L7520-labor, 15 min. increments

We use L7510.

Try L5999 (x2)

We use L7510 with a U&C price we calculate from the manufacturer’s list
price. It is helpful to have the original date of service for the foot (put
that in the narrative section of the claim). When we replace the Spectra
sock too we also use L7510 and give it its own U&C price. I have had both
Medicare (Jurisdiction C) and private insurances pay for it when we bill it
this way.

1. we have detailed Rx signed by the Dr
2. I add some narrative to detailed Rx, describing what is being done. A
line or 2. To my knowledge, most billing s/w has add on lines that can have
narrative in them, describing repairs or replacements.
3. Proper modifiers is entered by billing dptmnt. It will be denied by
medicare w-out modifiers
4. I use L7520, Reapir px. device, labor component; L7510, repair px.
device, repair or replace minor parts; this is the one that needs $$
calculated for it
5. there’s 99 code, but it will be denied.
6. for major repairs or replacements, I use medical justification 2 page
form that we tug along with billing.
So far, I had no negative feedback from my billing dprtmnt. Also, denials of
this nature, under circumstance of ALL paperwork being 100% done right,
including LMJ and notes from MD, we appeal.

I feel, it is more of slamming Medicare with proper paperwork. At some
point, they can not legally deny the claim. Esp when it starts hitting
appeal levels.
Then again, if you calc in all the costs related to collecting all the
paperwork, submitting the claim, etc, etc – suddenly, it all becomes less
and less worth few bucks you spend on a shell.
Personally, I call local reps and have them shell exchanged “under
warranty”, if it ran out of it. Thereafter it’s what, 5 minutes to replace?
Unless you have to reshape cover and all that.
I do a lot of stuff for free. Not worth the hassle of starting all the
p-work. Costs $40 just to process file through the system.

5999 or 7510 the same amount of admin work on both

Use L7510 and L7520.

L7510 for the shell. Depending on the coverage( if Medicare) you have to
include the part

number, manufacturer, an explanation and medical reason for need. Also how
old it is may be

beneficial,i.e. when provided. In some cases the insurance will request an
invoice. If you

send the cost, with an explanation of your markup, if any. you may not have
to send later,

not usually Medicare on the initial billing but this varies somewhat by
region.

Also add the labor L7520, for the time to change the shell, list each
step(removal,

re-installation, cover re-attachment,etc) with time involved in your HAO
submission and

total. Remember your untis are 1/4 hour each, as I am sure you recall.

If you are an AOPA member you can call them, ask for Joe or Devon, and they
can answer

questions like this for your. It should be noted that people should not post
their markup on the listserve that could be a legal problem.

L5999 should not be used in this case. That is for an item that is not
classified. The foot

shell falls under a minor repair. Since the foot shell is not a separate
code it is not

appropriate to use an existing code with or without an RP, the RP is not
appropriate for O

& P. This is also one of many topics covered in the billing and coding
seminar they present 3 times per year.

Use the FOOT code with RP or RB modifier (replacement component) AND also
bill the appropriate amount of time L7520

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