Re: OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

Re: OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

Chasity Cunningham

4/16/2021

These are a list of codes that are EXCLUDED in the SNF billing. You will not get paid for soft goods.

L5050 L5600 L5651 L5697 L5818 L5974 L6570 L6650 L6805 L7260
L5060 L5610 L5652 L5698 L5822 L5975 L6580 L6655 L6810 L7261
LSIOO L561 I L5653 L5699 L5824 L5976 L6582 L6660 L6880 L7362
LSIOS L56!3 L5654 L5700 L5826 L5978 L6584 L6665 L688l L7364
L5150 L5614 L5655 L5701 L5828 L5979 L6586 L6670 L6882 L7366
L5160 L56!6 L5656 L5702 L5830 L5980 L6588 L6672 L6883 L7367
L5200 L5617 L5658 L5703 L5840 L5981 L6590 L6675 L6884 L7368
L5210 L5618 L566I L5704 L5845 L5982 L6600 L6676 L6885 L7400
L5220 L5620 L5665 L5705 L5848 L5984 L6605 L6677 L6920 L7401
L5230 L5622 L5666 L5706 L5850 L5985 L6610 L6680 L6925 L7402
L5250 L5624 L5668 L5707 L5855 L5986 L661 l L6682 L6930 L7403
L5270 L5626 L5670 L5710 L5856 L5988 L6615 L6684 L6935 L7404
L5280 L5628 L5671 L57ll L5857 L5990 L6616 L6686 L6940 L7405
L5301 L5629 L5672 L5712 L5858 L6050 L6620 L6687 L6945
L53l I L5630 L5673 L5714 L5859 L6055 L6621 L6688 L6950
L5312 L5631 L5676 L5716 L5910 L6100 L6623 L6689 L6955
L5321 L5632 L5677 L5718 L5920 L61IO L6624 L6690 L6960
L5331 L5634 L5678 L5722 L5925 L6120 L6625 L6691 L6965
L5341 L5636 L5679 L5724 L5930 L6130 L6628 L6692 L6970
LSSOO L5637 L5680 L5726 L5940 L6200 L6629 L6693 L6975
LSSOS L5638 L5681 L5728 L5950 L6205 L6630 L6694 L7007
L5510 L5639 L5682 L5780 L5960 L6250 L6632 L6695 L7008
L5520 L5640 L5683 L5781 L5961 L6300 L6635 L6696 L7009
L5530 L5642 L5684 L5782 L5962 L6310 L6637 L6697 L7040
L5535 L5643 L5685 L5785 L5964 L6320 L6638 L6698 L7045
L5540 L5644 L5686 L5790 L5966 L6350 L6640 L6703 L7170
L5560 L5645 L5688 L5795 L5968 L6360 L6641 L6704 L7180
L5570 L5646 L5690 L58l0 L5969 L6370 L6642 L6706 L7181
L5580 L5647 L5692 L581 I L5970 16400 L6645 L6707 L7185
L5585 L5648 L5694 L5812 L5971 L6450 L6646 L6708 L7186
L5590 L5649 L5695 L5814 L5972 L6500 L6647 L6709 L7190
L5595 L5650 L5696 L5816 L5973 L6550 L6648 L6715 L7191


Thank you,



Chasity Cunningham
Insurance and Billing Specialist
Shamrock Prosthetics Inc.



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-----Original Message-----
From: Orthotics and Prosthetics List < <Email Address Redacted> > On Behalf Of Waldner, Glen E
Sent: Wednesday, April 14, 2021 3:04 PM
To: <Email Address Redacted>
Subject: Re: [OANDP-L] OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

Had the same scenario in clinical practice. I explained to them that my license and certification was more important than billing for a prosthesis in a SNF and that they should consider their license more important also. The other facility that was providing service and ignoring the 2 day rule was eventually busted by the feds. One loop hole that is available is for the facility to discharge the patient and readmit after delivery of the prosthesis. Of course this takes some work on the facility but it does make it legal.

Glen Waldner, LPO, CPO



From: Orthotics and Prosthetics List < <Email Address Redacted> > On Behalf Of Elizabeth Roof
Sent: Wednesday, April 14, 2021 1:07 PM
To: <Email Address Redacted>
Subject: [EXTERNAL] [OANDP-L] OPINION- DELIVERING A CUSTOM PROSTHETIC TO A SNF PATIENT

**** External Email - Use Caution ****

Our office was referred by an orthopedic surgeon to fit a new amputee with a prosthesis and we have been working with the SNF facility that the patient is in currently to do so. It has come down to delivering out the item and we notified the facility that we are unable to deliver a prosthesis to a patient in a part A stay in a SNF bed and the facility is responsible for the cost of the item. We told them that we cannot give the patient the item until 2 days before he is discharged home and they don't understand this. They want to be able to bill for therapy minutes on gait training and teaching him how to properly don/doff the prosthesis. The PT called the office today and stated that another local O&P facility in the area has delivered items out to them before for patients to complete therapy still in the SNF part A stay and she doesn't understand why we don't do the same. I've sent her all the items regarding proper Medicare billing practices for SNF stay patients on the Noridian Medicare Portal, but I am curious if any other facility has run into this same issue and what you've done to help educate other medical professionals on the billing guidelines we are to follow to stay compliant with Medicare. We of course want to continue to see the patient regarding his prosthesis as we have finished all fabrication, but also want to avoid improper billing procedures set forth by the payer.

Any tips or advice would be greatly appreciated!

Thanks in advance!

Liz Roof,
Billing Supervisor & Office Manager
15418 West Center Road
Omaha, NE 68144

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