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Linda Collins Blogger

More on the New Codes

Posted by Linda Collins | January 20, 2014

As we stated on December 9, 2013 in the R&R Bulletin, Medicare has modified the language of 23 already-existing L-codes to add the words, "prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise" to the end of the description. Simultaneously, it has created 23 new codes that have exactly the same descriptors as the 23 referenced in the previous sentence except for the fact that the quoted language above has been replaced by the words, "prefabricated, off the shelf."

A lot of questions and confusion have arisen because of the modified language. Providers wonder which code to bill and what is meant by "expertise." Here is what we do know.

What you do to the device determines the code. For instance, in the case of a Miami Lumbar Belt, if you custom-fit the product to the patient by trimming, bending, molding or assembling it, then L0631 is the appropriate code. On the other hand, if you take the product off your shelf and give it to the patient without trimming, bending, or otherwise customizing it, then HCPCS L0648 would be appropriate code.

Both HCPCS codes have the same product description (Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pad). The only differentiating language are the words describing what you, the supplier, do to the device (or, in the case of an OTS item, what you don’t do).

What does this mean for you?

You and your team need to track what kinds of modifications, if any, you make to these products and accurately document those activities.  For example, “Patient was fit with a Miami Lumbar Belt. Trimmed the right side to fit patient’s waist.”

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