5-year rule and orthotics
Jim Andreassen
Description
Collection
Title:
5-year rule and orthotics
Creator:
Jim Andreassen
Date:
3/24/2003
Text:
Peggy Walker, who is a consultant for OPGA/OPGA recently met with the Region
C Medical Review team and would like me to pass on the following information
regarding orthotic billing and the 5-year rule. Please read her comments.
In a meeting with the Region C Medical Review team on Friday the 21st of
March the 5 year rule as it applies to the Orthotic codes was discussed. The
reason for the written reminder of the rule was given. The high increase of
duplication in billing of these codes was noted as a rising problem. In some
instances one patient was billed for 4 to 8 knee braces within a four month
time.
The clarification was given that if the patient has a need for a replacement
due to a documented change in condition (weight gain or loss; change in any
type for need for a different type of item that is fully documented in
physicians' records will be reviewed.) If an item is torn beyond repair and
cost of repair is greater than cost of a new item additional documentation
will be reviewed and in some instances pictures would help.
Please call Peggy at 800-401-3643 if you need further clarification on this
issue.
You just need to be careful of the words normal wear and tear. Make sure
there is good documentation in your records as well as physicians and you
will need an order for the replacement.
As stated above, feel free to give Peggy a call with any questions.
Jim Andreassen
President, OPGA
Phone: 800-214-6742
Fax: 888-449-0610
email: <Email Address Redacted>
HAVE YOU REGISTERED FOR THE HEARTLAND CONFERENCE 2003? REGISTER ONLINE AT
WWW.HEARTLAND2003.COM OR CALL 800.642.6065! MAY 28-31, WATERLOO, IA.
C Medical Review team and would like me to pass on the following information
regarding orthotic billing and the 5-year rule. Please read her comments.
In a meeting with the Region C Medical Review team on Friday the 21st of
March the 5 year rule as it applies to the Orthotic codes was discussed. The
reason for the written reminder of the rule was given. The high increase of
duplication in billing of these codes was noted as a rising problem. In some
instances one patient was billed for 4 to 8 knee braces within a four month
time.
The clarification was given that if the patient has a need for a replacement
due to a documented change in condition (weight gain or loss; change in any
type for need for a different type of item that is fully documented in
physicians' records will be reviewed.) If an item is torn beyond repair and
cost of repair is greater than cost of a new item additional documentation
will be reviewed and in some instances pictures would help.
Please call Peggy at 800-401-3643 if you need further clarification on this
issue.
You just need to be careful of the words normal wear and tear. Make sure
there is good documentation in your records as well as physicians and you
will need an order for the replacement.
As stated above, feel free to give Peggy a call with any questions.
Jim Andreassen
President, OPGA
Phone: 800-214-6742
Fax: 888-449-0610
email: <Email Address Redacted>
HAVE YOU REGISTERED FOR THE HEARTLAND CONFERENCE 2003? REGISTER ONLINE AT
WWW.HEARTLAND2003.COM OR CALL 800.642.6065! MAY 28-31, WATERLOO, IA.
Citation
Jim Andreassen, “5-year rule and orthotics,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/220744.
