Coding

Coding

Michael P Madden

2/28/2003

I just got off the phone with one of the ombudsman from Medicare Region
A. I had called to inquire about the use of certain add-on codes in
conjunction with a base code. I was hoping they could give me a
definitive answer, or some direction, per some confusion that has reared
it's ugly coding head (so far I have two diametrically opposite
determinations from Medicare (on paper!!!), and both of these are
inconsistent with what I was told by the AOPA coding committee... but
that is a topic for another discussion). Instead of getting any
clarification, I was blind sided by the ombudsman's statement that they
do not find L1844, L1855, L1858 or any other lower extremity knee
orthosis codes (or any other lower extremity codes previous to L1900) in
the policy manual, and therefore they may not be covered services under
Medicare policy....after my obvious initial shock, I was reassured that
this ombudsman had worked for several agencies and was quite proficient
when it comes to policy...and it's not in the policy manual... after I
remained insistent that these have been historically covered items
throughout the industry, but was unable to quote chapter and verse per
the policy manual, I was told just because it's listed in the fee
schedule doesn't mean it's a covered item, they don't find it in the
policy manual, but they would look into it and get back to me.

I looked through the policy manual, and did not find any specific
reference to coverage guidelines for knee orthosis. Is there any
specific coverage guidelines?

Thanks for any help per this matter...

Mike Madden, BOC, C.Ped

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