Re: L-Codes/Splinting/Charging for supplies

[Guest guest]

Debbie,

If your facility is billing Medicare, they will need to complete a CMS 855

Enrollment Application for Durable Medical Equipment Prosthetics Orthotics and

Supplies (DMEPOS) Suppliers.

If you facility is not billing Medicare, you will need to check with

individual payers to determine if they will accept HCPCS Level II codes and/or

will

cover DMEPOS. Be careful to read the description of the HCPCS Level II or

L-codes when billing as many of these codes include fitting and adjustment of a

prefabricated or custom fabricated splint. Accordingly, you would not bill

a 97760 plus an L-code that includes fitting and adjustment.

I personally prefer the HCPCS Level II Expert published by Ingenix. Their

address is P. O. Box 27116, Salt Lake City, UT 84127-0116 and toll free number

is 1.800.INGENIX (464.3649). Ingenix also publishes an annual Coding and

Payment Guide for Physical Therapist that has proven to be extremely valuable

resource tool for coding and billing of outpatient PT.

Hope this helps.

D. Cavitt, President

Medical Legal Alliance, L.L.C.

**************Ideas to please picky eaters. Watch video on AOL Living.

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2050827?NCID=aolcmp00300000002598)

[Guest guest]

Suzanne,

I work for a hand clinic in a private practice setting. We mostly

do custom fabricated splints. These are the L-codes found in the

HCPCS Level II Professional coding book. MOst if not all of the L-

codes include the fitting and adjustment(97760), and we used to bill

just the 97760 instead of the L-code. Reimbursement is much better

if you bill the L-code instead. Just billing 97760 was really not

covering the time,expense, and expertise involved for custom

fabrication. SO to answer questions

1) you want to bill the L-code for the custom fabbed splint, but

not the 97760 along with it

2)HCPCS Level II coding book

3) We have done both. Verification of benefits ahead of time should

tell you if the plan will pay for the splint. But again, you cant

bill for fitting and adj. if you bill for the splint. It needs to be

one or the other. We have had patients buy their splint at the

medical supply house and then we fit and adjust...and bill the 97760

code alone.

Cheri Freeman, CMRS

Mountain View Physical THerapy

>

> Hi Group,

>

> I have a multi-part question that relates to fabrication of

splints as

> well as pre-fab splints (specifically for hand/wrist). We are a

hospital

> based outpatient clinic. We normally use CPT 97760 for fabrication

of

> custom splints. My questions are:

>

> 1. Can we additionally use L-codes to charge for supplies?

> 2. Where can I get a list of L-codes?

> 3. Does anyone collect cash for supplying pre-fab splints

to

> patients or is it most cost effective to try to bill L-codes for

pre-fab

> splints, or do you have the patient obtain these on their own?

(For finger

> flexion wraps, finger extension splints, banana splints, etc.)

>

> In the remote past, we simply gave these types of pre-fab splints

to

> patients and tried to bill insurance. Unfortunately, our cost for

these

> items is sometimes upwards of $20 for an extension splint which we

were

> basically supplying to the patient free-of-charge because we

weren't

> getting reimbursed by insurance for supplies!

>

> Any input would be appreciated.

>

>

> Suzanne LeBlanc, PT, MPT

> Director, Rehabilitation Services

> Willamette Falls Hospital

> Oregon City, OR

>

> x6870

> =========================================================

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[Guest guest]

Facilities such as hospitals, SNF's, rehab agencies,

and CORF's do not require a DME supplier to bill their

Medicare contractor for L codes under outpatient

therapy. The revenue code used for the L codes is 274.

PTs and OTs in private practice do require a DME

supplier number to bill their Medicare contractor. The

below is taken from Section 10 of the link below:

http://www.cms.hhs.gov/manuals/downloads/clm104c20.pdf

SNFs, CORFs, OPTs, and hospitals bill the FI for

prosthetic/orthotic devices, supplies,

and covered outpatient DME and oxygen (refer to §40).

Rick Gawenda, PT

President, Section on Health Policy & Administration

APTA

--- mlavcavitt@... wrote:

> Debbie,

>

> If your facility is billing Medicare, they will need

> to complete a CMS 855

> Enrollment Application for Durable Medical Equipment

> Prosthetics Orthotics and

> Supplies (DMEPOS) Suppliers.

>

> If you facility is not billing Medicare, you will

> need to check with

> individual payers to determine if they will accept

> HCPCS Level II codes and/or will

> cover DMEPOS. Be careful to read the description of

> the HCPCS Level II or

> L-codes when billing as many of these codes include

> fitting and adjustment of a

> prefabricated or custom fabricated splint.

> Accordingly, you would not bill

> a 97760 plus an L-code that includes fitting and

> adjustment.

>

> I personally prefer the HCPCS Level II Expert

> published by Ingenix. Their

> address is P. O. Box 27116, Salt Lake City, UT

> 84127-0116 and toll free number

> is 1.800.INGENIX (464.3649). Ingenix also publishes

> an annual Coding and

> Payment Guide for Physical Therapist that has proven

> to be extremely valuable

> resource tool for coding and billing of outpatient

> PT.

>

> Hope this helps.

>

> D. Cavitt, President

> Medical Legal Alliance, L.L.C.

>

>

>

> **************Ideas to please picky eaters. Watch

> video on AOL Living.

>

(http://living.aol.com/video/how-to-please-your-picky-eater/rachel-campos-duffy/

> 2050827?NCID=aolcmp00300000002598)

>

>

> [Non-text portions of this message have been

> removed]

>

>

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