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Linda Collins Blogger

New Audit Issue…Watch Your Back

Posted by Linda Collins | February 11, 2014

The Region A Recovery Auditor has posted a new issue for review. The identified issue is “Spinal Orthoses: Thoracic Lumbar Sacral Orthoses and Lumbar Sacral Orthoses.” The specifics of the audit include a review of correct billing codes and supporting medical necessity documentation.

Currently the issue is only under review in Region A and Region D, but we believe it likely that the other two Medicare Regions will pick up the issue for review in the near future.

What can you do to minimize the impact of an audit on spinal orthoses?

Follow the product definitions, codes and diagnoses outlined in the LCDs and Policy Articles. Also, check that your documentation supports the medical necessity for the orthoses. Specifically, confirm that the beneficiary's medical record contains documentation showing that the soinal orthoses was ordered for one of the following:

  • To reduce pain by restricting mobility of the trunk; or
  • To facilitate healing following an injury to the spine or related soft tissues; or
  • To facilitate healing following a surgical procedure on the spine or related soft tissue; or
  • To otherwise support weak spinal muscles and/or a deformed spine.

You can download the “Spinal Orthoses Claims Checklist” for further information.

Spinal Orthoses Claims Checklist

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