Hello List
Here are the only responses to my post of a couple of weeks ago:
—–Original Message—–
From: Orthotics and Prosthetics List [mailto:OANDP-L@LISTS.UFL.EDU] On
Behalf Of OS1023@AOL.COM
Sent: Monday, February 21, 2005 10:25 AM
To: OANDP-L@LISTS.UFL.EDU
Subject: [OANDP-L] what’s in a code?
Hello List
I has always been my understanding that an L-code necessarily describes both
device and service, including measurement and/or casting, fitting, some
follow-up, etc. I have been asked by a non- o and p provider “why can’t I
charge an appointment or other fitting fee? Where is it written? – it is hard
to find
definitive written confirmation. Can anyone point me to such documentation.
On a related note, is there any similar documentation regarding the practice
of coding a device based on function? I know of manufacturers and others who
“recommend” a fracture brace code for a walking boot or wrist splint if the
diagnosis is a fracture. To me, this is a straightforward misapplication of
the coding system, but I would like to have clear, written material to that
effect, from CMS, DMERCs, SADMERC, or anyone. Thanks for any help.
Tom Heckman CO
Subj: RE: [OANDP-L] what’s in a code?
Date: 2/21/2005 5:08:03 PM Eastern Standard Time
From: bb95@1800flo-tech.com
Tom:
It’s your business – you should charge whatever you need to, to stay
profitable. Medicare will not recognize the charges but you should be able
to collect these fees prior to starting treatment (kind of a down payment).
Charge for a certain number of appointments specific to the degree of
difficulty of the procedure and include any others that go over that amount
up to an agreed upon amount of time (60 days, etc.). When you bill insurance
only the L-codes will appear on the bill since you have already satisfied
your arrangements with your patient’s visa vie charges for appointments.
Hope this helps and is not contrary to any law, I am not aware of.
Bob Brown, Sr, CPO, FAAOP
Subj: RE: [OANDP-L] what’s in a code?
Date: 2/21/2005 6:45:55 PM Eastern Standard Time
From: jim.price@mindspring.com
Hi Tom,
The subject you have chosen is near and dear to my heart.
Medicare policy specifically states that all of the things you have
mentioned are included in Medicare’s reimbursement. If the claim is being
paid by another third party payor, it depends on your agreement with them.
If there is no agreement or contract precluding separate charges for service
performance, it is up to you. If the patient is cash pay, it is up to you.
I have been of the opinion for many years that ours is a service-oriented
profession rather than a “hardware” profession. This means that in many
cases we are in fact billing for what we accomplish. One example is
multiaxial rotation in a prosthetic foot. If the foot provides multiaxial
rotation capability but doesn’t necessarily have a separate multiaxial
rotation unit, how should the provider bill? If side bars for an orthosis
come with a non-corrosive finish, should the provider bill the non-corrosive
finish or consider it inclusive? It might be argued that if the provider is
restricted from billing additions to components that are not
assembled/applied in-house, an incentive is created to change the component
to meet the financial needs of the provider.
I am not a proponent of upcoding or unbundling, however I am not willing to
be a hardware salesman when I have been trained to provide a medical
service. By and large, HCPCS is a service-oriented rather than
product-oriented system- But there is much room for improvement in the O & P
reimbursement system across the board. Until improvements are made, it is
incumbent upon the provider to stand ready to justify his or her actions.
Jim Price, PhD, CPO
