splint application fee responses
allison boynton
Description
Collection
Title:
splint application fee responses
Creator:
allison boynton
Date:
10/28/2008
Text:
Thank you to all who responded to me query about splint application fees. Listed below are the replies that I received. I hope you find them helpful, I did.
Allison Beck, CPO
Beck's Healthcare, LLC
156 N. Main Street
Clayton, GA
My reply to this would be..if you have and billing questions regarding O&P, call your Medicare region and see what they tell you. Also, remember, you are not a doctor. Doctor's have their own set of rules. We are classified DME, and if you read your coding manuals from Medicare you will know that all fitting and adjustments are inclued in the procedure code
I am not familiar with the numbers you've included in your email. Are these L-codes?
The L-codes
I have found out West, that it is not uncommon for physicians and therapists
to bill an HCPC code and either a CPT code for therapy time or procedure
code for fitting. This is not a generally accepted practice by the O and P
community, though you will hear different outside our small circle. It is
very common in stock and bills where the DME entity bills a HCPC and the
physician's office bills time, hence the questionability of this style of
practice.
HCPC codes are set by CMS to include reimbursement to the clinician for
time, materials, fitting and adjustments. Whether it is ethical to bill
both an HCPC code and other codes for time spent fitting and adjusting is
something the physician should inquire about with CMS.
Just my 2 cents.
Eric O'Guinn, CPO
The 29125 and 29515(among others) are for application of plaster or fiberglass splints. There are also several codes for application of casts. These 5 digit CPT codes do not apply to pre-fab wrist, ankle or knee splints/braces. The application fee for the pre-fab products is included in the L code.
To maximize the office reimbursement, it would be advisable to put the patient in a fiberglass splint and then transition to a pre-fab splint. This would allow the office to capture both the CPT and L code reimbursement.
Let me know if you have any questions.
Mark Root
The doctor can bill any CPT code. He may not get reimbursed at the same time as he/she is dispensing an orthosis.
Marshall Katz,CO
Those codes can not be used by an O&P office which would have to use L
codes but if you are set up to bill medical service codes then they should
be OK to use as long as you are doing what the code says. I know that
podiatrists and physical therapists make foot orthotics and they use a
casting gee and a dispensing fee plus the fee for the foot orthosis. You
should get others opinions also. I will be eager to see your responses you
get.
Bryan Finley CP
You have to back up for what you bill, in other words why do you think this should be an added code to your service.
In our profession the delivery is part of the application to make sure everything checks out. So I do not think it would be appropriate for you to bill twice. However if your MD refers them to a OT OR PT then perhaps they could justify how the splint is host useful when applied for the activities of daily living. I am sure the therapists have a pre-printed form for this. Otherwise I think CMS would say you are charging for services that you regularly provide under that code anyway and the result is fraud.
Allison Beck, CPO
Beck's Healthcare, LLC
156 N. Main Street
Clayton, GA
My reply to this would be..if you have and billing questions regarding O&P, call your Medicare region and see what they tell you. Also, remember, you are not a doctor. Doctor's have their own set of rules. We are classified DME, and if you read your coding manuals from Medicare you will know that all fitting and adjustments are inclued in the procedure code
I am not familiar with the numbers you've included in your email. Are these L-codes?
The L-codes
I have found out West, that it is not uncommon for physicians and therapists
to bill an HCPC code and either a CPT code for therapy time or procedure
code for fitting. This is not a generally accepted practice by the O and P
community, though you will hear different outside our small circle. It is
very common in stock and bills where the DME entity bills a HCPC and the
physician's office bills time, hence the questionability of this style of
practice.
HCPC codes are set by CMS to include reimbursement to the clinician for
time, materials, fitting and adjustments. Whether it is ethical to bill
both an HCPC code and other codes for time spent fitting and adjusting is
something the physician should inquire about with CMS.
Just my 2 cents.
Eric O'Guinn, CPO
The 29125 and 29515(among others) are for application of plaster or fiberglass splints. There are also several codes for application of casts. These 5 digit CPT codes do not apply to pre-fab wrist, ankle or knee splints/braces. The application fee for the pre-fab products is included in the L code.
To maximize the office reimbursement, it would be advisable to put the patient in a fiberglass splint and then transition to a pre-fab splint. This would allow the office to capture both the CPT and L code reimbursement.
Let me know if you have any questions.
Mark Root
The doctor can bill any CPT code. He may not get reimbursed at the same time as he/she is dispensing an orthosis.
Marshall Katz,CO
Those codes can not be used by an O&P office which would have to use L
codes but if you are set up to bill medical service codes then they should
be OK to use as long as you are doing what the code says. I know that
podiatrists and physical therapists make foot orthotics and they use a
casting gee and a dispensing fee plus the fee for the foot orthosis. You
should get others opinions also. I will be eager to see your responses you
get.
Bryan Finley CP
You have to back up for what you bill, in other words why do you think this should be an added code to your service.
In our profession the delivery is part of the application to make sure everything checks out. So I do not think it would be appropriate for you to bill twice. However if your MD refers them to a OT OR PT then perhaps they could justify how the splint is host useful when applied for the activities of daily living. I am sure the therapists have a pre-printed form for this. Otherwise I think CMS would say you are charging for services that you regularly provide under that code anyway and the result is fraud.
Citation
allison boynton, “splint application fee responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/229692.
