Responses to: appropriate IPOP add on codes

Responses to: appropriate IPOP add on codes

Randy McFarland

3/1/2004

Hi List members-
   Below are the responses I received from the list regarding my
question. Later this month, the L Coding Committee will be discussing
this issue and I'll forward their answer to this list when I hear from
them. Randy

ORINGNAL QUESTION
   Are there any appropriate add on procedure codes for a standard TT
plaster Immediate Post Op Prosthesis, (L 5400) for a Medicare patient?
I have concerns with using add ons that are already listed in the base
procedure. How about if is a prefab plastic IPOP or if it is a
non-Medicare patient?

RESPONSES separated by a blank line

It has been my understanding that you can't use add ons to postop
or temporary type prosthesis. They are to be used just as they are.

I'd suggest directing questions like this to AOPA's coding committee.
Though I'm no longer on that committee it's a sure bet whatever advise
they provide will be consistent with Medicare. Those 5400 series codes
have been discussed at length and I believe were intended to be stand
alone codes (no additions). Medicare also does not expect them to be
billed to the DMERC and will usually deny because they believe they are
part A procedures.

L5400
L5910 - ALIGNABLE SYSTEM IF PRESENT IS NOT IN BASE CODE
L5684 - FORK STRAP
L5688 - WAIST BELT
THIS IS WHAT I USE IN REGION C

I just did one ,private, IPOP Flotec, and added waist belt, fork strap
,end
pad ,stump sock and feel they are legitimate add ons.

I hope you are using this code for in patient (part A). Out patient,
under part B is not a covered item any more (region B).
If the add on is already in base code, I would not use it. Unless
whatever you are doing is a completely different item and you can prove
it is a different item with the same type name.
I would love to do more IPOP's. The hospitals are just not allowing the
service since manage care has been around.