BLANKET DENIAL OF l2275 AND l2820 FOR AFOs

BLANKET DENIAL OF l2275 AND l2820 FOR AFOs

doer human

11/7/2008

Good morning, everyone.
To follow on my yesterday's post:
1. great thanks to all who replied.
2. general agreement was to make sure that KX modifier was submitted along
with the codes and make absolute sure that chart notes support them! (we are
still researching why, in our case, *per billing person*, Medicare will not
permit her to use KX mod on L1900 codes)
3. AOPA was of great help either:


Igor,



We have seen this problem recently and we believe it is a processing error
on the part of the DME MAC. The new knee orthosis policy requires the use
of a KX modifier on all knee base and addition codes. Several of the DME
MACs put edits in place on all lower extremity orthosis addition codes that
caused an automatic denial if the KX modifier was missing. They did not
take into account that many of the addition codes used for Kos are also used
with AFOs and KAFOs. We brought this to their attention and they have been
trying to correct it since. While the number of denials we have seen have
come way down, there are still some limited instances where this is a
problem.



AOPA will follow up with the DME MACs to make sure they have addressed this
issue. In the meantime, I would recommend that you appeal this denial
immediately.





Thanks,



Joe McTernan



Joseph McTernan
(571) 431-0876 ext. 211

--
However many holy words you read, however many you speak, what good will
they do you if you do not act on upon them? - Buddha