FW: Jurisdiction B News: Coding Instructions - Otto Bock C-Leg
Jim DeWees
Description
Collection
Title:
FW: Jurisdiction B News: Coding Instructions - Otto Bock C-Leg
Creator:
Jim DeWees
Date:
7/1/2008
Text:
I am subscribed to an online message system with Medicare, and there are occasionally some worthwhile and useful emails that come to me. This one I felt was one of the useful emails with good information, and that it might help a few people out there with the questions about the C-leg billing and their rules and all.
Here is the information and email straight from Medicare Jurisdiction B.
Jim DeWees, CP
Subject: Fw: Jurisdiction B News: Coding Instructions - Otto Bock C-LegDate: Mon, 30 Jun 2008 17:34:29 -0400
----- Original Message -----
From: Jurisdiction B DME MAC
To: <Email Address Redacted>
Sent: Monday, June 30, 2008 3:25 PM
Subject: Jurisdiction B News: Coding Instructions – Otto Bock C-Leg
Coding Instructions – Otto Bock C-Leg®
Recently during a claim review, it was noted that suppliers were billing the miscellaneous code L5999 for two functions of the Otto Bock C-Leg® lower extremity prosthesis - “continuous gait assessment, computerized MKP prosthesis” and “electronically controlled static stance regulator, adjustable.” This coding is not correct. The on-board, real-time gait analysis and stance regulation are accomplished by the microprocessors in the Otto Bock knee (code L5856). There is no separate billing and reimbursement for these functions since the allowance for these functions are included in the reimbursement for code L5856.
According to the SADMERC, the following are the only HCPCS codes billable for the Otto Bock C-Leg®:
L5828 – Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5845 – Addition, endoskeletal knee-shin system, stance flexion feature, adjustable
L5848 – Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
L5856 – Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5920 – Addition, endoskeletal system, above knee or hip disarticulation, alignable system
L5930 – Addition, endoskeletal system, high activity knee control frame
L5950 – Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
Suppliers are reminded that for any questions regarding the correct coding of products to access the Durable Medical Equipment Coding System (DMECS) at <URL Redacted> or contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) Coding Helpline at 1-877-735-1326.
For all questions relating to the Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, suppliers should contact the Competitive Bidding Implementation Contractor (CBIC) at:
<URL Redacted>
CMS has also announced the first 10 metropolitan areas in which competition will occur, as well as the first items to be competitively bid. For additional information visit the CMS Web site at: <URL Redacted>
Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.
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Here is the information and email straight from Medicare Jurisdiction B.
Jim DeWees, CP
Subject: Fw: Jurisdiction B News: Coding Instructions - Otto Bock C-LegDate: Mon, 30 Jun 2008 17:34:29 -0400
----- Original Message -----
From: Jurisdiction B DME MAC
To: <Email Address Redacted>
Sent: Monday, June 30, 2008 3:25 PM
Subject: Jurisdiction B News: Coding Instructions – Otto Bock C-Leg
Coding Instructions – Otto Bock C-Leg®
Recently during a claim review, it was noted that suppliers were billing the miscellaneous code L5999 for two functions of the Otto Bock C-Leg® lower extremity prosthesis - “continuous gait assessment, computerized MKP prosthesis” and “electronically controlled static stance regulator, adjustable.” This coding is not correct. The on-board, real-time gait analysis and stance regulation are accomplished by the microprocessors in the Otto Bock knee (code L5856). There is no separate billing and reimbursement for these functions since the allowance for these functions are included in the reimbursement for code L5856.
According to the SADMERC, the following are the only HCPCS codes billable for the Otto Bock C-Leg®:
L5828 – Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control
L5845 – Addition, endoskeletal knee-shin system, stance flexion feature, adjustable
L5848 – Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability
L5856 – Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
L5920 – Addition, endoskeletal system, above knee or hip disarticulation, alignable system
L5930 – Addition, endoskeletal system, high activity knee control frame
L5950 – Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal)
Suppliers are reminded that for any questions regarding the correct coding of products to access the Durable Medical Equipment Coding System (DMECS) at <URL Redacted> or contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) Coding Helpline at 1-877-735-1326.
For all questions relating to the Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program, suppliers should contact the Competitive Bidding Implementation Contractor (CBIC) at:
<URL Redacted>
CMS has also announced the first 10 metropolitan areas in which competition will occur, as well as the first items to be competitively bid. For additional information visit the CMS Web site at: <URL Redacted>
Remember! National Government Services' Jurisdiction B DME MAC List Serve is for out going messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time, Thank you! CONFIDENTIALITY NOTICE: This E-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply E-mail and destroy all copies of the original message.
To unsubscribe/change profile: click here.
Email list management powered by http://MailerMailer.com
_________________________________________________________________
Need to know now? Get instant answers with Windows Live Messenger.
http://www.windowslive.com/messenger/connect_your_way.html?ocid=TXT_TAGLM_WL_messenger_072008
Citation
Jim DeWees, “FW: Jurisdiction B News: Coding Instructions - Otto Bock C-Leg,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 26, 2024, https://library.drfop.org/items/show/229576.
