Re: Documentation Support for L5910 Addition with base code L5637
Michelle Jones
Description
Collection
Title:
Re: Documentation Support for L5910 Addition with base code L5637
Creator:
Michelle Jones
Date:
10/24/2019
Text:
Good morning.
We have received 2 denials for the same thing. We stated in our dispute that:
1. CMS policy is to add on codes to the base descriptor, L5910 is an add-on code & that there is NO base code that includes the alignable system. L5910 is a specific add on code to describe a component of the prosthesis that is medically necessary for the proper fit and function of the prosthesis.
2. We provided justification for why it was medically necessary for that particular patient to have an alignable system & why it is an integral component of the prosthesis (be specific to your patient).
Be prepared-we are now on our second level of appeal for both patient denials.
I am very interested in any other approaches and/or outcomes to this issue.
Has anyone had issues with any other unusual denials from Humana?
Michelle Jones
Progressive Prosthetic & Orthopedic Services, Inc.
380 Cleveland Place
Virginia Beach, VA 23462
Phone: (757) 456-5501
Fax: (757) 671-7525
Email: <Email Address Redacted>
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On Behalf Of James R. Loehrke
Sent: Wednesday, October 23, 2019 3:26 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Documentation Support for L5910 Addition with base code L5637
We had Humana deny L5910 Alignable code because in the descriptor for base code L5530 it uses the phrase “non-alignable system”. For level 1 review explanation was given that the base code by itself “is” non-alignable to make the prosthesis alignable you have to add L5910. That didn’t work. Can anyone point me in the right direction for documentation/support that these codes can be billed together?
James R. Loehrke
- CEO, Vice President
Green Prosthetics & Orthotics LLC
2241 Peninsula Drive
Erie, PA 16506
Phone: 814.833.2311 x12
<URL Redacted>
Join us on Facebook!
<URL Redacted>
We have received 2 denials for the same thing. We stated in our dispute that:
1. CMS policy is to add on codes to the base descriptor, L5910 is an add-on code & that there is NO base code that includes the alignable system. L5910 is a specific add on code to describe a component of the prosthesis that is medically necessary for the proper fit and function of the prosthesis.
2. We provided justification for why it was medically necessary for that particular patient to have an alignable system & why it is an integral component of the prosthesis (be specific to your patient).
Be prepared-we are now on our second level of appeal for both patient denials.
I am very interested in any other approaches and/or outcomes to this issue.
Has anyone had issues with any other unusual denials from Humana?
Michelle Jones
Progressive Prosthetic & Orthopedic Services, Inc.
380 Cleveland Place
Virginia Beach, VA 23462
Phone: (757) 456-5501
Fax: (757) 671-7525
Email: <Email Address Redacted>
-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On Behalf Of James R. Loehrke
Sent: Wednesday, October 23, 2019 3:26 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Documentation Support for L5910 Addition with base code L5637
We had Humana deny L5910 Alignable code because in the descriptor for base code L5530 it uses the phrase “non-alignable system”. For level 1 review explanation was given that the base code by itself “is” non-alignable to make the prosthesis alignable you have to add L5910. That didn’t work. Can anyone point me in the right direction for documentation/support that these codes can be billed together?
James R. Loehrke
- CEO, Vice President
Green Prosthetics & Orthotics LLC
2241 Peninsula Drive
Erie, PA 16506
Phone: 814.833.2311 x12
<URL Redacted>
Join us on Facebook!
<URL Redacted>
Citation
Michelle Jones, “Re: Documentation Support for L5910 Addition with base code L5637,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/209682.
