Reponses to L5910 & L5920 question

Reponses to L5910 & L5920 question

Carol Berryann

9/22/2014

Please find below, the replies I received from the following post:

 

We recently received the following response from our local VA regarding the
alignable system code:

You cannot use L5920 to replace a single component on a socket replacement.
L5920 is to be used for a complete new prosthesis. With a socket
replacement, you would use L5999..

I am inquiring as to if this is also AOPA's or Medicare's interpretation of
the code?

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Yes you can only use that code for a new device. Another travesty that our
association has allowed for us at this point.

 

That has been a rule for the 20 years I've been in O and P. AOPA and
Medicare rules, to my understanding...

 

We would say L5700 or 5701 etc for the socket with other codes allowed
(acrylic, carbon...). However, the alignable 5920 would not since the
original socket (assumes gray plate or similar) you can reuse the alignable
component.

 

Makes perfect sense to me.

 

It is my position at that code should be paid if the alignable component is
an integral part of that replacement socket ie a pyramid or female
receptacle. If the end of the socket is a four hole plate they may consider
that Nonalignable. However in order to do a socket replacement the old sock
it has to be removed the new one has to be put on and realigned hence the
Alingnable code.

 

My understanding is that code is for a whole pylon kit. If you look at the
long description of socket replacement it does include socket adapter which
you could charge for small part if you needed to put it into the prosthesis
to complete the socket replacement beyond the socket adaptor.

 

They are correct...you should use L7510

 

Many years ago when I was on the AOPA coding committee it was their
position that L5920 was a once per prosthesis code. Understand that the
AOPA coding committee have chosen to always take the conservative position
on code usage

 

The base code for a socket replacement includes the socket adaptor. The
remainder of the endoskeletal system is being reused'

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Thanks for your help,

 

Carol Berryann

Assistant Practice Manager

 

Office: 845-339-4775

Fax: 845-339-4793

Email: <Email Address Redacted>

Website: www.POAprosthetics.com

 

 


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