responses: Billing for Valve Replacement

responses: Billing for Valve Replacement

orthotic prosthetic

3/6/2001

Question was:

> AK patient loses/breaks screw-in valve for suction socket. What L-code
> should be used to bill for a replacement?


Responses (thanks everybody):
L7510 and L7520 Clean and simple

I believe an L5999 code with description and priced at 1.4 times the
purchase
price is the correct way to do it

L7510

Why not use the L5999 code. That is the code to use for any not
otherwise specified item. Nothing else should be used. Find a copy of the
Medicare manual in your employers office and read through the Lcodes. It
is
fairly easy to see what has a code and what needs to be listed as an not
otherwise specified code. I hope this helps.

code for labor and parts

I assume this is a Medicare patient since you are reluctant to use the
999
or materials codes. I stopped trying to fool around with 999 codes or
labor and material codes years ago when Medicare began to make it
non-efficiant and illogical to attempt billing using these procedures.
For
any prosthetic repair I use the code that describes the part of the
device
that is being repaired and apply the 52 modifier with an appropriate
fee
assigned. For example: L5652-52 Screw-in suction valve (appropriate
fee).
If you adhere to a price x 3 formula and the valve costs you $20.00,
your
assigned charge would be $60.00. The 52 modifier indicates a reduced
service, which certainly justifies its application to the L5652 Suction
Suspension procedure code. I have used this method in both Regions B and
C
with no denials. Feel free to post this response to the listserv if you
like, however I would appreciate your deletion of the actual pricing
examples. Good luck.

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