Orthopedic Coding Alert

A lack of documentation for devices, such as corsets, provided to Medicare patients in an office setting can cause problems when sorting out payment possibilities.

Internal hardware for the vertebral column has become stronger and more commonplace over the last two decades, explains Judy Theisen, RN, at the University of Iowa department of orthopaedics. She says, [Orthopedists] wont be using the brace so much in the future. In the past, the brace was used to give three points of immobilization, and was used after cervical spine surgery. The HCPCS L code for the Somi (L0190, cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars [Somi, Guilford, Taylor types]) is still available.

Today, a much lighter cervical halo is used to transfer the weight of the head to the shoulders after a cervical surgery. Codes L0810-L0860 apply to cervical halo, and the choice depends on the type of halo. L0810 (halo procedure, cervical halo incorporated into jacket vest) is a basic model. L0860 is more specific (addition to halo procedure, magnetic resonance image compatible system).

According to section 2133 of the Medicare Carriers Manual, appliances for the back and neck are covered when furnished incident to physicians services or on a physicians orders.

Orthopedists do not make much use of codes for devices for the neck and torso for several reasons:

Domain of the neurosurgeon: Although orthopedic surgeons do undertake various laminectomy procedures, the higher the vertebral segments involved, the more likely a neurosurgeon is to do the surgery. Thus, a laminectomy involving the cervical region (e.g., 63001, laminectomy with exploration and/or decompression of spinal cordcervical), which would include the application of a cervical bracee.g., halo, collarin some cases, is more likely to be done by a neurosurgeon.

Orthopedists often write the prescription: Various back bracessacroiliac, sacrolumbar, dorsolumbar corsets and beltsare a large part of this category. In most cases an orthopedist prescribes the brace and a supply company takes care of the rest.

A representative of Majors Medical in Bala Cynwyd, Pa., explains, We supply 90 percent of the time directly to the patient and accept prescriptions for such items with assignment if possible from the patients carrier. If we are out of network, we supply a HCFA 1500 form, necessary for the patient to get reimbursed directly also.

Orthopedists supply the device in the office: There are times when an orthopedist supplies a corset or similar device to the patient directly. Even though the deviceon hand in the orthopedists officeis supplied incident to the E/M service, it can be billed. (Save the purchase invoices for Medicare patients since bills for such devices often are subject to audit when supplied by the physician.)

Carrier discretion applies: Almost all L-coded devices are reimbursed with carrier discretion. Most are also under the jurisdiction of the Durable Medical Equipment regional carrier (DMERC) for Medicare claims.

Note: For more information on billing for orthotics and supplies, see Accurate Billing Will Optimize Supplies/Orthotics Payment on page 19 of the March 2000 Orthopedic Coding Alert and Correct Coding Maximizes Payment for Supplies/Orthotics on page 30 of the April 2000 issue.