I attended the AOPA coding seminar earlier this month and I have some
questions that (in retrospect) were not sufficiently addressed.
#1. A fellow C.P. and I have a wager ( a dozen Krispy Kreme doughnuts) as
to who is correct regarding the use of the L-code L-5940 when replacing a
BK socket (L-5700). The official medicare descriptors for L-5940 and
L-5700 state “Addition, endoskeletal system, below knee ultralight
material (titanium, carbon fiber or equal), and “Replacement, socket,
below knee, molded to patient model”. Note that L-5700 does not specify
endoskeletal, nor does it include the attachment plate. He believes he
should use L-5940 because the socket will be made with carbon fiber (we
both agree L-5629, acrylic socket, is appropriate) and include a pyramid
socket adaptor (attachment). He argues this is an ultralight system. I
believe L-5940 should not be used because use of carbon fiber for the
socket is irrelevant and the pyramid socket adaptor does not represent a
endoskeletal system. What do you think?
#2. How does one bill Medicare for a BK prostheses ready to be fit ( NOT
COMPLETED) when you find out the patient was hospitalized and died in the
hospital? I think only the socket and inserts should be billed for
because the other components are still new and can be used for another
prosthesis. The billing would include all socket, suspension/insert
codes, but no codes for textiles, endoskeletal components, or the foot.
My other concern is the billing date of service. I can’t use the date of
death because he was in the hospital and would be under part A of
medicare. Should I use the date of his last appointment at my office when
the negative plaster impression and measurements were obtained? Help!
James M. Mc Coy C.P., L.P., FAAOP
