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Linda Collins Blogger

Updates to Spinal Orthoses LCDs effective January 1, 2013

Posted by Linda Collins | January 07, 2013

​The four DME MACs recently announced an update to the Spinal Orthoses Local Coverage Decisions. The changes include more detailed information about Detailed Written Orders (DWO) and documentation requirements. It appears the DME MACs will be focusing on physician records to justify the medical necessity for the device. In other words, even if a prescription from a physician is received there will need to be documentation in the doctor’s records to support the need for the orthoses.

Based upon these changes, it is likely the MACs and/or RACs will begin auditing this issue. Which means that after payment on the claim, the auditor may come to you and ask for copies of the supporting documentation? If you do not have this in your files the claim will be denied retrospectively and the money will be recouped by Medicare.

Going forward the best practice will be to have a signed and dated DWO and a physician’s report or copies of medical records prior to dispensing the TLSO. The documentation in the beneficiary’s medical records must show the TLSO was ordered for one of the following indications:

  • 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.

A summary of requirements for a TLSO claim are provided for your reference:

Requirements for TLSO Claims Checklist.pdf

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