USA Billing - L2820 - Response summary
Ted Trower
Description
Collection
Title:
USA Billing - L2820 - Response summary
Creator:
Ted Trower
Date:
9/5/2002
Text:
My question was:
Ok, obviously I'm spending some time going thru the billing codes. I've
had someone tell me that they bill L2820 - Addition to Lower Extremity
Orthosis, Soft Interface for Molded Plastic, Below Knee Section, when
delivering a knee orthosis if it has a soft liner as most do. I've never
done this and have my doubts. Can anyone tell me if this has been their
practice? I will delete names before posting a summary to the list. If
you can describe your reasoning in using the code it would be very helpful.
Here are the responses I received:
-------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
If there is a good reason for asking the questions you're asking, it's to
show that there is NO RIGHT WAY to code. HCFA has never published so much
as a guideline, never mind rules to govern the use of HCPCS codes. The
entire system is grossly unfair. My belief is that there is at least as
much under-utilization as there is over-utilization, and it is because of
these types of questions you have gotten non-consensus answers to.
Until someone bothers to define these codes, they will continue to confuse
both practitioners and payors, alike.
-------------------------------------------------------------------------------------------------------------
First concerning L2275 the code was specific to the afo and not to other
joints in the body. Second if the knee orthosis is custom made by you then
any addition are billed. If the orthosis os produced by another company like
Don Joy, Lenox Hill, or Innovation Sports then you can only bill for
additional liners if additional liners were provided not what comes mounted
on the orthosis as a finished product. Same goes for poly centric knee joints
if the orthosis coded is for argument sake a CTI2 then you cannot breakout or
unbundle. Hope this helps.
-------------------------------------------------------------------------------------------------------------
IT DEPENDS A CUSTOM FABRICATED KNEE WITH SOFT FOAM LINER
OR REMOVABLE CLOTH LINER QUALIFIES. AN OFF THE SHELF
WITH A CLOTH COVER IS VERY IFFY AND I STOPPED USING IT
1/01 WHEN MEDICARE CLARIFIED THE DISTINCTION BETWEEN
PREFAB AND CUSTOM AND ADDED THE MOLDED PLASTIC TO THE
CODE DESCRIPTION IT PREVOIUSLY BEING ONLY SOFT
INTERFACE BELOW KNEE. I'VE BEEN TOLD L3995 FRACTURE
SOCK OR EQUIVALENT IS OKAY FOR OFF THE SHELF.
-------------------------------------------------------------------------------------------------------------
>Ted,
>
>It is my understanding that when a practitioner assigns codes to a delivered
>device he is, in effect, describing the device using a coding system that a
>computer can easily understand.
>
>To that end, a practitioner has the responsibility to ACCURATELY describe
>the device and should not under-code and thereby leave out componentry, or
>over-code to gussy-up something just to get higher reimbursements.
>
>Unless I code for the liners above and below the knee of a prefabricated or
>custom KO, that patient never received them.
>
>In general, I look at the base codes and see what they include and what
>codes are needed to finish describing the orthosis or prosthesis.
>
>Could I provide a KO without any lining or padding in the thigh and calf
>sections, sure. I wouldn't, but I could. That's the only time I would not
>use a 2820 or 2830 code.
-------------------------------------------------------------------------------------------------------------
You cannot L2820 or L2830 code with L1858 OR L1844 as they are included in
the base code. This would be considered unbundling. Both L1858 and L1844
had padding to both upper and lower sections when the codes were initially
approved. Using these L codes will become a bigger problem when the HIPPA
regulations are in place.
-------------------------------------------------------------------------------------------------------------
Got your other question on the liners for KO, wanted to comment:
I believe you should rarely add L2820 or L2830 to Knee orthoses.
Most of the devices that have rigid frames had pads inthem when designed and
the allowables were calculated.
The L2820 and L2830 codes were developed to add liners to AFOs and KAFOs,
these devices having coverage on the calf or thigh respectively.
The only time I think it,conservatively speaking, would be acceptable would
be when you have a devices that has a thigh and/or calf shell which you are
custom fabricating. The code was not necessarily padded and therefore
padding could be added.
For me that would limit these additions to L1855 - I think for any of the
others it would not be conservative.
-------------------------------------------------------------------------------------------------------------
In my opinion that does not go here. As you stated, the brace comes w/ a
liner; that is part of the brace and that is inclusive in the L code of the
brace. So adding the 2820 is fraud in my opinion. This is what the OIG
loves to see us do so they can be there w/ a sharp knife to cut off our
balls. The 2820 is designed as an add on for a brace that you manufacture
and add padding from the knee level down, including the foot. This is also
a bone of contention for thoses of us that do pediatrics. Some say you can
use it to bill out some of the DAFO's. However if you look at the
kindergarten sketches that we are to follow from in the Guideline book it
shows that the foot is also padded for the L2820. Therefore you be the
judge. Do you want the OIG knocking on your door? (so you can sing suprano
in the church choir) Or do you want to get a few less sheckles for your
efforts? Good luck w/ your decision.
-------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
Again there is no clear concensus. Even very experienced billers appear to
take opposite positions on these addition type codes. In several messages
there have been references to rulings from HCFA about specific applications
of the codes. Do these exist or are they legend? Is there a central
location where all such rulings have been compiled or are they scattered
among the companies who requested/required the clarification. I've been
doing this for 21 years now and I never any of these in writing except the
HCFA letter on the Toe-Off AFO and that was given to me by the distributor
of the product.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
Ok, obviously I'm spending some time going thru the billing codes. I've
had someone tell me that they bill L2820 - Addition to Lower Extremity
Orthosis, Soft Interface for Molded Plastic, Below Knee Section, when
delivering a knee orthosis if it has a soft liner as most do. I've never
done this and have my doubts. Can anyone tell me if this has been their
practice? I will delete names before posting a summary to the list. If
you can describe your reasoning in using the code it would be very helpful.
Here are the responses I received:
-------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
If there is a good reason for asking the questions you're asking, it's to
show that there is NO RIGHT WAY to code. HCFA has never published so much
as a guideline, never mind rules to govern the use of HCPCS codes. The
entire system is grossly unfair. My belief is that there is at least as
much under-utilization as there is over-utilization, and it is because of
these types of questions you have gotten non-consensus answers to.
Until someone bothers to define these codes, they will continue to confuse
both practitioners and payors, alike.
-------------------------------------------------------------------------------------------------------------
First concerning L2275 the code was specific to the afo and not to other
joints in the body. Second if the knee orthosis is custom made by you then
any addition are billed. If the orthosis os produced by another company like
Don Joy, Lenox Hill, or Innovation Sports then you can only bill for
additional liners if additional liners were provided not what comes mounted
on the orthosis as a finished product. Same goes for poly centric knee joints
if the orthosis coded is for argument sake a CTI2 then you cannot breakout or
unbundle. Hope this helps.
-------------------------------------------------------------------------------------------------------------
IT DEPENDS A CUSTOM FABRICATED KNEE WITH SOFT FOAM LINER
OR REMOVABLE CLOTH LINER QUALIFIES. AN OFF THE SHELF
WITH A CLOTH COVER IS VERY IFFY AND I STOPPED USING IT
1/01 WHEN MEDICARE CLARIFIED THE DISTINCTION BETWEEN
PREFAB AND CUSTOM AND ADDED THE MOLDED PLASTIC TO THE
CODE DESCRIPTION IT PREVOIUSLY BEING ONLY SOFT
INTERFACE BELOW KNEE. I'VE BEEN TOLD L3995 FRACTURE
SOCK OR EQUIVALENT IS OKAY FOR OFF THE SHELF.
-------------------------------------------------------------------------------------------------------------
>Ted,
>
>It is my understanding that when a practitioner assigns codes to a delivered
>device he is, in effect, describing the device using a coding system that a
>computer can easily understand.
>
>To that end, a practitioner has the responsibility to ACCURATELY describe
>the device and should not under-code and thereby leave out componentry, or
>over-code to gussy-up something just to get higher reimbursements.
>
>Unless I code for the liners above and below the knee of a prefabricated or
>custom KO, that patient never received them.
>
>In general, I look at the base codes and see what they include and what
>codes are needed to finish describing the orthosis or prosthesis.
>
>Could I provide a KO without any lining or padding in the thigh and calf
>sections, sure. I wouldn't, but I could. That's the only time I would not
>use a 2820 or 2830 code.
-------------------------------------------------------------------------------------------------------------
You cannot L2820 or L2830 code with L1858 OR L1844 as they are included in
the base code. This would be considered unbundling. Both L1858 and L1844
had padding to both upper and lower sections when the codes were initially
approved. Using these L codes will become a bigger problem when the HIPPA
regulations are in place.
-------------------------------------------------------------------------------------------------------------
Got your other question on the liners for KO, wanted to comment:
I believe you should rarely add L2820 or L2830 to Knee orthoses.
Most of the devices that have rigid frames had pads inthem when designed and
the allowables were calculated.
The L2820 and L2830 codes were developed to add liners to AFOs and KAFOs,
these devices having coverage on the calf or thigh respectively.
The only time I think it,conservatively speaking, would be acceptable would
be when you have a devices that has a thigh and/or calf shell which you are
custom fabricating. The code was not necessarily padded and therefore
padding could be added.
For me that would limit these additions to L1855 - I think for any of the
others it would not be conservative.
-------------------------------------------------------------------------------------------------------------
In my opinion that does not go here. As you stated, the brace comes w/ a
liner; that is part of the brace and that is inclusive in the L code of the
brace. So adding the 2820 is fraud in my opinion. This is what the OIG
loves to see us do so they can be there w/ a sharp knife to cut off our
balls. The 2820 is designed as an add on for a brace that you manufacture
and add padding from the knee level down, including the foot. This is also
a bone of contention for thoses of us that do pediatrics. Some say you can
use it to bill out some of the DAFO's. However if you look at the
kindergarten sketches that we are to follow from in the Guideline book it
shows that the foot is also padded for the L2820. Therefore you be the
judge. Do you want the OIG knocking on your door? (so you can sing suprano
in the church choir) Or do you want to get a few less sheckles for your
efforts? Good luck w/ your decision.
-------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
Again there is no clear concensus. Even very experienced billers appear to
take opposite positions on these addition type codes. In several messages
there have been references to rulings from HCFA about specific applications
of the codes. Do these exist or are they legend? Is there a central
location where all such rulings have been compiled or are they scattered
among the companies who requested/required the clarification. I've been
doing this for 21 years now and I never any of these in writing except the
HCFA letter on the Toe-Off AFO and that was given to me by the distributor
of the product.
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
Citation
Ted Trower, “USA Billing - L2820 - Response summary,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/219735.
