AFO/KAFO LCD
Paula Rogerson-Doherty
Description
Collection
Title:
AFO/KAFO LCD
Creator:
Paula Rogerson-Doherty
Date:
9/1/2020
Text:
Hello List,
About 2 weeks ago Joe Porter posted about the new language in the AFO/KAFO LCD regarding custom fabricated devices.
Below is the question I emailed to Noridian and their reply. I find this extremely troubling. I have requested more information from them and passed it onto AOPA.
I am very concerned this is another avenue for claim denials or payment delays.
I would suggest that everyone review this, read the LCD and be fully informed.
I emailed Noridian the following:
Hello Shanda,
I'm not sure if you are the one to contact but I have a concerning question in regards to the updated AFO/KAFO LCD.
Under the General Requirements Section of the Policy Article there is a heading with some unclear statements following:
MISCELLANEOUS
In addition, if the item is custom fabricated, a complete and clear description of the item, including what make this item unique, and a breakdown of charges (materials and labor used in fabrication). This information must be entered into the narrative field of an electronic claim.
Is this referring to Miscellaneous Codes? Unlisted procedure codes? Or does this statement apply to all custom fabricated codes for AFO/KAFO's? It is troublesome and I would appreciate clarification. I am not sure why Noridian would need this for a code with description and established fee.
I would appreciate your assistance with clarifying this language and what it actually applies to.
Thank you
Noridian's Reply:
Good Morning Paula,
Your question was shared with one of our Senior Nurse Reviewers, Emily, who is included here, with the following response:
The requirements of this reference, ...a complete and clear description of the item, including what make this item unique, and a breakdown of charges (materials and labor used in fabrication), applies to all custom fabricated codes, not miscellaneous or other codes.
I hope this helps-Thank you,
Confidentiality Notice: This email, including attachments, is covered by the Electronic Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy regulations and, as such, is confidential and may be legally privileged. It is intended for the use of the individual or entity to which it is addressed and may contain certain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this email is not the intended recipient or agent responsible for delivering or copying this communication and attachments, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply to the sender that you received it in error, then delete it. Thank you for your cooperation.
About 2 weeks ago Joe Porter posted about the new language in the AFO/KAFO LCD regarding custom fabricated devices.
Below is the question I emailed to Noridian and their reply. I find this extremely troubling. I have requested more information from them and passed it onto AOPA.
I am very concerned this is another avenue for claim denials or payment delays.
I would suggest that everyone review this, read the LCD and be fully informed.
I emailed Noridian the following:
Hello Shanda,
I'm not sure if you are the one to contact but I have a concerning question in regards to the updated AFO/KAFO LCD.
Under the General Requirements Section of the Policy Article there is a heading with some unclear statements following:
MISCELLANEOUS
In addition, if the item is custom fabricated, a complete and clear description of the item, including what make this item unique, and a breakdown of charges (materials and labor used in fabrication). This information must be entered into the narrative field of an electronic claim.
Is this referring to Miscellaneous Codes? Unlisted procedure codes? Or does this statement apply to all custom fabricated codes for AFO/KAFO's? It is troublesome and I would appreciate clarification. I am not sure why Noridian would need this for a code with description and established fee.
I would appreciate your assistance with clarifying this language and what it actually applies to.
Thank you
Noridian's Reply:
Good Morning Paula,
Your question was shared with one of our Senior Nurse Reviewers, Emily, who is included here, with the following response:
The requirements of this reference, ...a complete and clear description of the item, including what make this item unique, and a breakdown of charges (materials and labor used in fabrication), applies to all custom fabricated codes, not miscellaneous or other codes.
I hope this helps-Thank you,
Confidentiality Notice: This email, including attachments, is covered by the Electronic Communications Privacy Act, 18 USC 2510-2521, and the HIPAA privacy regulations and, as such, is confidential and may be legally privileged. It is intended for the use of the individual or entity to which it is addressed and may contain certain information that is privileged, confidential, and exempt from disclosure under applicable law. If the reader of this email is not the intended recipient or agent responsible for delivering or copying this communication and attachments, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply to the sender that you received it in error, then delete it. Thank you for your cooperation.
Citation
Paula Rogerson-Doherty, “AFO/KAFO LCD,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/255196.
