Responses to missing modifier

Responses to missing modifier

Michael P Madden

1/28/2003

Thanks to all who replied,

Below is a snap shot of the replies I received....Thanks again too
all....

Mike Madden, BOC(O&P), C.Ped

~~~~~~~~~~~~~~~~~~~
Michael,
I have had a similar situation with Medicaid. I took pictures of the
foot deformity to show the case manager that a non orthopedic shoe would
not fit the patient properly and feet would have potential breakdown.
Shoes were covered. There is also a modifier for shoes attached to
braces ZX? not sure.
~~~~~~~~~~~~~~~~~~~
What region are you from? It may make a difference. If you are in region
B, you use the L3649 code, with ZX, and include a description of the
shoes, why they are medically necessary, and you may have to include some
other information, depending on who reviews the claim. But it should be
covered if you can convince them they are medically necessary for the
proper functioning of the brace. Check your policy on orthopedic shoes
and attachement to braces when not standard, i.e. high-top, extra depth
and custom. If you have not been to an AOPA Coding and Billing Seminar, I
cover this, and many other areas related to medicare billing for
Orthoitcs.
~~~~~~~~~~~~~~~~~~
Mike: I saw your post regarding custom molded shoes on metal AFO. The new
rules regarding any footwear code used with AFOs states that they are
covered when attached. You can call them and get the allowed amount for
the custom molded shoe code L3230.
Then bill with the KX modifier, should absolutely be covered and paid.
How are you?
~~~~~~~~~~~~~~~~~~
You would use L3224 or L3225 code and KX  is the
modifier that you are required to use when a shoe is attached to the
brace.  This modifier is usually used when billing Acodes and
getting the diabetic shoe forms signed, however MCR states to use this
modifier when billing shoes attached to the brace. (That is what tells
them that it truely is attached).  Only one shoe is covered, the
other shoe that is not attached to the brace will be considered non
covered and if you use the ZY modifier it will increase the claims
processing time at
~~~~~~~~~~~~~~~~~
i am not aware of any.
~~~~~~~~~~~~~~~~~
Yes shoes are covered for non-diabetic patients if they are attatched to
a brace. As for a modifier, you could use KX and enclose a letter
stating that they are attatched. If there is another modifier I don't
know what it would be. KX stands for supporting documentation enclosed.
Let me know how this works for you. Also by the way it's coded out with
the attatchment of shoe to new brace code, they should be able to figure
it out.
~~~~~~~~~~~~~~~~~
With regards to your question, shoes attached to braces for
non-diabetics. The modifier you should use id GA and of course LT or RT.
 Good luck!
~~~~~~~~~~~~~~~~~
on a shoe attached to an orthosis a KX modifier is necessary plus LT RT
for bilateral

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