Medicare Billing Questions
JAMES M MCCOY
Description
Collection
Title:
Medicare Billing Questions
Creator:
JAMES M MCCOY
Date:
12/16/2002
Text:
I attended the AOPA coding seminar earlier this month and I have some
questions that (in retrospect) were not sufficiently addressed.
#1. A fellow C.P. and I have a wager ( a dozen Krispy Kreme doughnuts) as
to who is correct regarding the use of the L-code L-5940 when replacing a
BK socket (L-5700). The official medicare descriptors for L-5940 and
L-5700 state Addition, endoskeletal system, below knee ultralight
material (titanium, carbon fiber or equal), and Replacement, socket,
below knee, molded to patient model. Note that L-5700 does not specify
endoskeletal, nor does it include the attachment plate. He believes he
should use L-5940 because the socket will be made with carbon fiber (we
both agree L-5629, acrylic socket, is appropriate) and include a pyramid
socket adaptor (attachment). He argues this is an ultralight system. I
believe L-5940 should not be used because use of carbon fiber for the
socket is irrelevant and the pyramid socket adaptor does not represent a
endoskeletal system. What do you think?
#2. How does one bill Medicare for a BK prostheses ready to be fit ( NOT
COMPLETED) when you find out the patient was hospitalized and died in the
hospital? I think only the socket and inserts should be billed for
because the other components are still new and can be used for another
prosthesis. The billing would include all socket, suspension/insert
codes, but no codes for textiles, endoskeletal components, or the foot.
My other concern is the billing date of service. I can't use the date of
death because he was in the hospital and would be under part A of
medicare. Should I use the date of his last appointment at my office when
the negative plaster impression and measurements were obtained? Help!
James M. Mc Coy C.P., L.P., FAAOP
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questions that (in retrospect) were not sufficiently addressed.
#1. A fellow C.P. and I have a wager ( a dozen Krispy Kreme doughnuts) as
to who is correct regarding the use of the L-code L-5940 when replacing a
BK socket (L-5700). The official medicare descriptors for L-5940 and
L-5700 state Addition, endoskeletal system, below knee ultralight
material (titanium, carbon fiber or equal), and Replacement, socket,
below knee, molded to patient model. Note that L-5700 does not specify
endoskeletal, nor does it include the attachment plate. He believes he
should use L-5940 because the socket will be made with carbon fiber (we
both agree L-5629, acrylic socket, is appropriate) and include a pyramid
socket adaptor (attachment). He argues this is an ultralight system. I
believe L-5940 should not be used because use of carbon fiber for the
socket is irrelevant and the pyramid socket adaptor does not represent a
endoskeletal system. What do you think?
#2. How does one bill Medicare for a BK prostheses ready to be fit ( NOT
COMPLETED) when you find out the patient was hospitalized and died in the
hospital? I think only the socket and inserts should be billed for
because the other components are still new and can be used for another
prosthesis. The billing would include all socket, suspension/insert
codes, but no codes for textiles, endoskeletal components, or the foot.
My other concern is the billing date of service. I can't use the date of
death because he was in the hospital and would be under part A of
medicare. Should I use the date of his last appointment at my office when
the negative plaster impression and measurements were obtained? Help!
James M. Mc Coy C.P., L.P., FAAOP
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affilliations should be used in all communications.
Citation
JAMES M MCCOY, “Medicare Billing Questions,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/220173.
