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Correct Coding – RT and LT Modifier

Until now, suppliers billing for bilateral DME devices including therapeutic shoes for patients with diabetes, diabetic inserts, custom AFOs or custom foot orthoses, have been able to submit electronic claims by indicating the total quantity and using the RTLT modifier on a single line OR by using RT on one line and LT on another, noting half the quantity on each.

Beginning March 1, 2019, such claims MUST be submitted using two separate lines, using the RT and LT modifier on each. Units of service (UOS) should be “1″ on each line for shoes and for AFOs; it should be up to “3″ on each line, for prefabricated or custom diabetic inserts. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and / or LT modifier or with RTLT on a single claim line, will be rejected as incorrect coding.

Suppliers who have been submitting codes for bilateral devices using one line are advised to start billing on two separate lines NOW and not wait until March 1.

As always, each claim line should also include the modifier KX to indicate that all required compliance documentation is on file. When billing L3000 for custom foot orthotic devices, the GY modifier should be used to indicate that the item is statutorily excluded and cause the claim to deny.

For a link to the Medicare carrier website and Policy Articles, see:

https://med.noridianmedicare.com/web/jadme/policies/dmd-articles/2018/correct-coding-rt-and-lt-modifier-usage-change

Medicare DME Reimbursement Increases in 2019

Good news!
On January 1, 2019, Medicare increased the amount it pays for diabetic shoes, Moore Balance Brace and Arizona custom AFOs.

While the amounts paid may vary slightly by state, the National Fee Schedule is as follows:
Depth Shoes (A5500): pair $146.42
Prefabricated, Heat Molded Inserts (A5512): pair $59.72
Custom Milled Inserts (A5514): pair $89.12
Depth Shoes w/3 pr. Prefab, Heat Molded Inserts: $325.36
Depth Shoes w/3 pr. Custom Molded Inserts: $413.78
Custom Molded Shoes w/offset heels and rocker bottoms: $656.62
Arizona AFO, Standard (L1940, L2330, L2820): each – Ceiling $1178.61, Floor $904.29
Moore Balance Brace (L1940, L2330, L2820): pair – Ceiling $2357.22, Floor $1808.58

For a complete listing of updated DME allowables, including prefabricated and custom ankle-foot orthoses, visit:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME19-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

Medicare DME Reimbursement Increases in 2018

Good news!
On January 1, 2018, Medicare increased the amount it pays for diabetic shoes, Moore Balance Brace and Arizona custom AFOs.

While the amounts paid may vary slightly by state, the National Fee Schedule is as follows:
Depth Shoes (A5500): pair $143.12
Prefabricated, Heat Molded Inserts (A5512): pair $58.38
Custom Molded Inserts (A5513): pair $87.12
Depth Shoes w/3 pr. Prefab, Heat Molded Inserts: $318.26
Depth Shoes w/3 pr. Custom Molded Inserts: $404.48
Custom Molded Shoes w/offset heels and rocker bottoms: $570.38
Arizona AFO, Standard (L1940, L2330, L2820): each – Ceiling $1178.61 Floor $883.96
Moore Balance Brace (L1940, L2330, L2820): pair – Ceiling $2357.22 Floor $1767.92

For a complete listing of updated DME allowables, including prefabricated and custom ankle-foot orthoses, visit:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME18-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

New Billing Codes for Plantar Fascia Night Splints, Pneumatic and Non-pneumatic Walking Casts

Medicare now differentiates between off-the-shelf and custom fitted type prefabricated AFOs including pneumatic and non-pneumatic walkers and plantar fascia night splints.

Traditionally used codes reflect the custom fitted version and the allowable amounts for both are currently the same.  For devices traditionally billed using L4360, L4386 and L4396, new codes reflecting the off-the-shelf definition most likely apply.

Click below to read entire article:

NEW BILLING CODES FOR PLANTAR FASCIA NIGHT SPLINTS, 150127

Effect of Sequestration on DME

Questions and AnswersQuestion: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts?

Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application of the current fee schedule, coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. All fee schedules, Pricers, etc., are unchanged by sequestration; it’s only the final payment amount that is reduced.

Question: How is the 2% payment reduction under sequestration identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)?

Answer: Claim adjustment reason code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.

Continue Reading…

Shoe Orthoses Reduced Diabetes-Related Amputations

Long-term use of shoe orthoses significantly reduced diabetes-related amputations, according to study results recently presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India.

Researchers studied 114 Swedish patients with diabetes and a risk of developing foot ulcers. Over 2 years, patients wore one of three different types of shoe orthoses.

Results showed that the use of orthoses, podiatry, education and regular check-ups helped patients avoid foot ulcers. Overall, only 0.9% of participants developed new foot ulcers during the first year vs. an industry average of 3% to 8% reported in similar diabetic populations.

Continue Reading…

 

Loss Of Balance Is Leading Cause Of Elderly Falls

by Jessica Stoller-Conrad

Accidental falls are one of the leading causes of injury death in people over 65 worldwide, but for a long time researchers have struggled to understand just how they happen.

What they do know is that many older patients have cognitive impairment, and even the most conscientious medical staff can have trouble remembering details of a fall. So a group of researchers in British Columbia decided to use a round-the-clock video in a long-term care facility to observe accidental falls right as they happen.

Their study, published in the The Lancet, found that most of the 227 falls caught on video happened because the patients lost their balance, not because they slipped or tripped.

But what causes this momentary loss of balance?

Continue Reading…

Be an AFO Expert – It’s Easy if You Use DME Protocols

Time and time again I am asked the same four questions about AFOs:

  1. When should they be used
  2. What’s the correct diagnosis code
  3. What HCPCS code should be used for the AFO
  4. How much does it pay?

While Medicare does not offer definite answers to any of these questions, it does offer guidance in the form of LCDs, Letter of Common Determination and fee schedules.

SafeStep features free webinars on DME Treatment Protocols and another on Compliance.  To register, simply click here, http://www commande cialis.safestep.net/Members/WebinarInfo.asp.  Recorded versions of presentations can also be found in “Library” section of SafeStep website. Even if you have seen this presentation in the past, it’s worth attending again as codes and requirement continue to change.

In collaboration with leaders of the American Academy of Podiatric Management and other knowledgeable practioners, SafeStep created the DME Treatment Protocols booklet.  This guide offers a step by step approach to devices that will effectively work for the most commonly seen biomechanical conditions and offers guidance of how to bill and how much to charge.  While not intended to be followed explicated, it offers practioners an effective starting point and way to developer’s ones own approach to care.  To get your copy of this valuable guide, cont

Once protocols are established, they should be combined with an effective inventory management routine so that the office is certain to always have in stock products for the most commonly seen condition but not so much inventory as to take up valuable office space.  When effectively implemented into office routines, staff should put possible devices out for the doctor to consider so that easily available to discuss with the patient.  If indicated for a Medicare patient, the device can be dispensed on the spot, no prior authorization is necessary.

Gait Evaluation Determined to be Effective Early Indicator of Dementia

The New York Times recently reported  that gait evaluation can be an accurate early indicator of Alzheimer’s disease and other  causes of cognitive impairment.  Studies show that when people’s thinking slows, their walking ability declines almost in parallel.   Experts say that by focusing on gait, physical therapists and doctors may be the first to recognizing dementia and offer approaches to improve mobility.  There is also speculation that exercises to improve fitness and coordination can help stave off dementia.

To read the article, click here:
http://www.nytimes.com/2012/07/17/health/research/signs-of-cognitive-decline-and-alzheimers-are-seen-in-gait.html?pagewanted=2&ref=science