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Posted by David McGill | February 21, 2013

MAC Region B issued new guidance yesterday about how to appropriately bill L5999, the code for "not otherwise classified" prosthetic components. The requirements, "effective immediately," provide that claims using an NOC code must include

    a concise description of the code,
    a concise description of the item billed,
    the manufacturer's name,
    the product name and number,
    the model and serial number, and
    the manufacturer's suggested retail price.

These new requirements further support a hypothesis that we first wrote about nearly a month ago.
In our posts of January 28, 2012 (Check Your Feet!) and February 5, 2013 (The Coding Revolution), we specifically posited that the MACs will increasingly focus on the specific product delivered to a patient. In less than a month, we have now received MAC guidance about 3 separate issues, all of which share the same key element: an explicit link between codes and specific products. Whether it's prepayment claim reviews for specific foot codes, product-specific directives for microprocessor knees, or yesterday's news from Region B, it's clear that the MACs want to more closely examine or control codes selected by suppliers.

What does this mean for you?

In Region B, it means that you need to be sure that your use of an L5999 code truly describes a unique product feature, as all of the supporting information you are now required to include links that L5999 to a specific manufacturer and product. More broadly, as we stated in January, it means that O&P's across the country "must take care to only bill those codes that clearly apply to the product being delivered."

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