ORIGINAL POST:
Is anyone aware if a master list exists of L codes (at least for
prefabricated items) used in our profession? Some manufacturers have
asked the AOPA L-Coding committee to render an opinion as to
recommended L-Codes for their products. Other manufacturers offer
documentation from SADMERC to verify what codes can be used. Some
manufacturers are reluctant to even make suggestions.
While I can understand that coding for some custom devices could
be subject to interpretation, it seems that most prefabricated devices
(unless significantly altered to modify the original functions) should
be subject to universally agreed upon L-Codes.
Not doing this opens us up to additional scrutiny when payers
wonder about the variety of billings from our profession for the same
items. As we’ve seen, unethical billing practices (even from outside
our profession) negatively impacts us through mistrust and skepticism.
If the O and P profession would get on the same page regarding the
prefabricated items we fit, outsiders who try to abuse the coding system
will be more easily identified when pay sources perform audits of
L-Codes we commonly provide.
Ultimately a cross-referencing of prefab products to our fee
schedule would be a time saver and would help billings from our
industry/profession be more consistent and trusted. I’ll post
responses!
Randy McFarland, CPO Fullerton, CA
RESPONSES:
I have contacted SADMERC numerous occasions to resolve the very
question you just posed with the response that the manufacturer should
submit the device for evaluation and if the specific device has not
been submitted they ask that you send it with a copy of your
manufacturers invoice for evaluation. To my way of thinking SADMERC is
basing the allowable charge on the item cost only not service follow
up, measurement or fitting. While I agree with your basic idea, the
follow through should be done by the Academy not AOPA or even a
manufacturer. Until they get off their butts and get in this fight the
way AAOS has championed orthopedics things will only get worse.
Look at the product classification lists at
http://www.palmettogba.com/palmetto/Other.nsf/$$ViewTemplate+for+Docs?Re
adForm&Other+Medicare+Partners/SADMERC/Product+Classification+Lists
A PRAFO can be fitted to off-load an ulcer or to control a
contracture. Different codes would apply for each function. Depending
upon the FUNCTION of the device the proper billing code can change.
Donjoy’s division, Pro-Care, providing ready-made devices publishes
such a list. Ask your rep.
