The jury has reached a verdict. Don’t use these codes for replacement
sockets.
The responses:
Personally I think that is milking the system
It is my understanding that the socket lamination adapter is part of
the socket replacement protocol – therefore, no I do not use these
codes.
When I adjudicate claims, I consider that these two codes have already
been paid when providing the original prosthesis and should not be
re-billed with a replacement socket.
The coding committee just discussed this at a recent meeting and it is
their consensus that the conservative position is that L5910 and L5940
codes apply to an entire prosthesis and should only be billed once per
base code billing.
AOPA in 2004 changed their bottom language in their illustrated guide
for L5940-L5960 from: “Ultra lightweight components (that) can be added
to (an) endoskeletal prostheses for patient energy conservation.” to “A
global code including any ultra-light materials encompassing all areas
of the prosthesis, intended to be used once per base code.”
It is also my understanding that if ultralight and alignable were
billed in the original prosthesis they therefore are not able to be
billed in the socket change.
Thanks again
Aryeh
