L coding
Randall McFarland, CPO
Description
Collection
Title:
L coding
Creator:
Randall McFarland, CPO
Text:
Hello List-members,
It was suggested at the recent L-coding seminar that the GA modifier be
used whenever we bill for an item that we believe to be non-covered. Some
practitioners I've talked to are concerned that this might be a red flag
which would likely trigger automatic denial.
Have any of you had experience using the GA modifier? Has it influenced
payment in any way? Regardless, when you bill say, L8499 (unlisted
procedure), you'll likely need to have very good documentation, explaining
the medical necessity of the item (NOT for convenience or comfort) to have a
chance of getting paid.
For instance, a donning tube would likely be justifiable if it were to
prevent damage to the recent surgery, while if it were only to prevent
discomfort when donning a shrinker, it wouldn't be covered.
I will post responses. If you don't want your name included, put it in
parentheses.
Have a good weekend!
Randy McFarland, CPO
Sunny Hills Orthopedic Services, Inc.
Fullerton , CA
It was suggested at the recent L-coding seminar that the GA modifier be
used whenever we bill for an item that we believe to be non-covered. Some
practitioners I've talked to are concerned that this might be a red flag
which would likely trigger automatic denial.
Have any of you had experience using the GA modifier? Has it influenced
payment in any way? Regardless, when you bill say, L8499 (unlisted
procedure), you'll likely need to have very good documentation, explaining
the medical necessity of the item (NOT for convenience or comfort) to have a
chance of getting paid.
For instance, a donning tube would likely be justifiable if it were to
prevent damage to the recent surgery, while if it were only to prevent
discomfort when donning a shrinker, it wouldn't be covered.
I will post responses. If you don't want your name included, put it in
parentheses.
Have a good weekend!
Randy McFarland, CPO
Sunny Hills Orthopedic Services, Inc.
Fullerton , CA
Citation
Randall McFarland, CPO, “L coding,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/215701.
