Responses to Footshell reimbursement question
Gary Cheney, CPO
Description
Collection
Title:
Responses to Footshell reimbursement question
Creator:
Gary Cheney, CPO
Date:
10/27/1999
Text:
I would like to offer some comments relative to the responses posted regarding reimbursement for a footshell replacement.
1. What has been accomplished by billing for 2 units of L4205 ? You will be reimbursed for the TIME you have involved in the replacement, but not for the cost + margin of the footshell itself. Additionally I would be very cautious in billing an orthotic code (L4205) for a prosthetic procedure. The appropriate prosthetic code would be L7520. DMERC Supplier Manual states The time reported should ONLY be for laboratory repair time and associated evaluation. I am of the opinion that it means NO parts/components are to be billed under a repair/adjustment/labor code.
2. Karyn Schibanoff, Reimbursement Specialist of AOPA suggested the use of the RP modifier. Again quoting the DMERC Supplier Manual Replacement of components are billed using the base code for the component with the addition of the RP modifier. In the case of a footshell replacement there is NOT a base code for the component, hence no validity in use of the RP modifier.
3. My suggestion for coding of this replacement would be in the following manner:
L7510 (repair or replace minor parts) OR L5999 (not specified) for the cost + margin of
the footshell.
AND
L7520 (adjustment/repair) for the time involved in accomplishing the replacement.
Before the question is asked, I do not know or has anyone issued guidelines on what constitutes minor parts as stated in L7510.
Medicare has become the benchmark for our profession relative to coding/reimbursement issues, hence I use their guidelines for direction. Additionally I would like to say I am in total agremment with Ms. Schibanoff's remarks relative to documentation. Region D processes nearly all of our Medicare claims and we have pursued all denials through the review/hearing process. Our supporting documentation is very good and we have been successful in having nearly all denials overturned.
Gary A. Cheney, CPO
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1. What has been accomplished by billing for 2 units of L4205 ? You will be reimbursed for the TIME you have involved in the replacement, but not for the cost + margin of the footshell itself. Additionally I would be very cautious in billing an orthotic code (L4205) for a prosthetic procedure. The appropriate prosthetic code would be L7520. DMERC Supplier Manual states The time reported should ONLY be for laboratory repair time and associated evaluation. I am of the opinion that it means NO parts/components are to be billed under a repair/adjustment/labor code.
2. Karyn Schibanoff, Reimbursement Specialist of AOPA suggested the use of the RP modifier. Again quoting the DMERC Supplier Manual Replacement of components are billed using the base code for the component with the addition of the RP modifier. In the case of a footshell replacement there is NOT a base code for the component, hence no validity in use of the RP modifier.
3. My suggestion for coding of this replacement would be in the following manner:
L7510 (repair or replace minor parts) OR L5999 (not specified) for the cost + margin of
the footshell.
AND
L7520 (adjustment/repair) for the time involved in accomplishing the replacement.
Before the question is asked, I do not know or has anyone issued guidelines on what constitutes minor parts as stated in L7510.
Medicare has become the benchmark for our profession relative to coding/reimbursement issues, hence I use their guidelines for direction. Additionally I would like to say I am in total agremment with Ms. Schibanoff's remarks relative to documentation. Region D processes nearly all of our Medicare claims and we have pursued all denials through the review/hearing process. Our supporting documentation is very good and we have been successful in having nearly all denials overturned.
Gary A. Cheney, CPO
Signup for your free USWEST.mail Email account <URL Redacted>
Citation
Gary Cheney, CPO, “Responses to Footshell reimbursement question,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/212970.
