L4205,L4210 and ...999 code responses

L4205,L4210 and ...999 code responses

Michael P Madden

3/20/2000

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Date: Mon, 20 Mar 2000 20:04:04 -0500
Thanks to all who replied... question is re-posted responses to follow...


QUESTION:

Dear colleagues,

Over the past 1-2 years we have had intermittent success billing
(electronically) the codes requiring descriptions for reimbursement.
Specifically, the L4205 labor codes, the L4210 parts codes, and the
...999 codes (among others). We have been in contact with Medicare per
their requirements, and have tried to meet their requests (often getting
a different requirement depending on who we talk to), but find it is a
hit or miss process. We have not altered our narratives to any great
extent, (only by what has been requested), and find that sometimes we are
paid, and sometimes not. It almost seems to depend on who is reviewing
the narrative.
One of our biggest problem is billing minor replacements/adjustments
which require replacements and/or adjustments of custom fabricated items.
 They keep asking for invoices, for items for which no purchase invoice
exists!! We have tried to explain this is a custom fabrication item not
an item which has been purchased. Even when we try to narrate this (with
what limited space we are provided electronically), we are SOMETIMES
rejected for lack of information, and sometimes paid. Replacing a
joint or other component supplies an invoice, replacing a strap, molded
face shield on a custom helmet or similar fabrication item does not, and
seems to be a gamble.
The ...999 code are a nightmare in and of themselves. We do a lot of
very specialized fabrications which are not even within the consideration
of the L-code descriptors. To avoid any interpretation/misinterpretation
of the fallacy of close enough codes, we bill them as ...999 codes with
a descriptor. Again it seems to be a hit or miss process.
HHHHHHHHHHHHHHEEEEEEEEEEEEEEEEEEELLLLLLLLLLLLLLLLLLLLLLPPPPPPPPPPPPPPPP!!
!!!!!!!!!!!!!!!!!!!!!!
Please forward experiences, hints,successes, failures....information to
help us improve our legitimate reimbursement for services rendered.
I will post responses, if you want your names removed please request so.
Thanks in advance...
Mike M.

RESPONSES:

Dear Michael,

Unfortunately, Medicare does not have any easy reference check list of
what is necessary to accompany a code that is miscellaneous in nature.
* When the HA0 record is not enough room, consider sending the claim on
hard copy with the supporting documentation.
* Include a narrative description of the item, brand name (if it exists),
and a statement defining medical necessity of the item for the particular
patient.
* AOPA recommends that you describe work that was needed to modify item,
and amount of time it took, and list your costs relating to the item.
* When you don't have an invoice, brand name or model number, make sure
to note why that doesn't exist. For example: the device was custom
fabricated in my office.
An additional suggestion you may want to consider would be to illustrate
your work with a photo of the device when sending the hard copy claim.
Including information that will educate the claim reviewer may save you
time by answering the question before it is asked. I hope this has been
helpful to you. If you have any questions, please feel free to contact
me at the number or addresses listed below.
Karyn Schibanoff
Reimbursement Specialist / AOPA
1650 King Street, Suite 500
Alexandria, VA 22314
(703) 836-7116
(703) 836-0838 Fax
<Email Address Redacted>
web site: <URL Redacted>

Recently I started using repair forms that state exactly what the repair
was and how much time was spent. If parts were used, then I use the cost
plus a markup. Like you I don't always have an invoice for stock items,
ie. uprights, ankle joints. I jsut checked with my office manager and
find that most repairs are kicked back for more info. For a while(within
2 years) when I sent a narrative describing the original Oor P and what
had occured requiring the repair/modification, I was getting paid. If I
do a simple strap replacement, I often don't bother to bill because the
time spent arguing costs more than to just do the repair. However, I
just had to transfer all endo components because of a huge wearer weight
gain and you can bet I'd like to be paid for that. Thanks for asking the
question....I don't understand what the magic should be. We are now
billing all repairs by paper instead of electronic. As for 999 codes I
look forward to your responses.
Molly Pitcher, C.P.O.

Have you tried to contact Karyn Schibanoff the reimbursement specialist
at AOPA for any help?
 Bill DeToro, CO

We are trying to give all the possible info. up front with a paper
billing so we don't have to wait for a denial or a request for additional
information. It IS frustrating to get requests for non existant
invoices!!
Randy McFarland, CPO

Just one comment. We are asked routinely to provide an invoice to
particular insurance =companies for custom orthoses and prostheses. After
getting very frustrated=with trying to explain that there is no invoice
for custom work, we =have now started to create our own invoice. I use
Microsoft Excel and =
create our own invoice. I work in a hospital setting so I do have costing
information available =per procedure. I can not give you too much
feedback as to how sucessful =this has been yet. Good Luck
Steve Fletcher, CPO

Mike,
Your problem sounds almost like you're dealing with a government agency
or something! :) We have the same problems and I think you'll find that
everyone has this same dilemma. My only suggestion would be to NOT bill
electronically for these codes so that you have more area for
description. We define each piece of velcro (and how many inches used),
and state things like hand sewn, double stitched/sewn leather strap
attached to... We have had better success with our itemized and very
specific descriptions,
but it is still a hit and miss. Just slightly higher hits! Will be
interested to read your responses.
Joan Cestaro, CP
RPI- Winchester VA

Good Luck, this is the great question of 1900 & 2000. You are right, it
is just dependant on the processor.
Michele

I am having no problems with these codes by doing the following. I bill
electronically. In the narrative, I fully describe what I actually did.
With L4205, I describe the repair service in as much detail as possible
that will still fit into the allowed space. With the L4210, you must
provide the ACTUAL cost to provide and the mark up. This allows Medicare
to evaluate your charges. I am in Region D. This might be a problem for
you if you are in a different region. Recommend you also work through
AOPA, hopefully you are a member. With us all working through one
central source, we have more power. Hope this helps.
Keith

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