Wiki Billing DME foot orthotics with side specific diagnosis

[twoerpel]

I was asked by a provider what is the correct way to bill out foot orthotics with the new side specific ICD 10 diagnosis.

Say a member is diagnosed with Plantar Tendinitis of the left foot (M76.822 -Posterior tibial tendinitis, left leg). The provider wants to dispense a pair of foot orthotics as part of treatment.

What would be the correct way to bill this out?

A) L3010-LT, 1 unit, dx M76.822
L3010-RT, 1 unit, dx M76.822



B) L3010-LT, 1 unit, dx M76.822
L3010-RT ,1 unit, dx M76.821


C) L3010- LT/RT, 2 units, dx M76.822


My thought is C would be the correct way. In example A the dx is for left leg may conflict with modifier RT and in example B a diagnosis was plantar tendinitis was not given for the right by the physician so I don’t think it would be correct to assign it.


Thank you in advanced for any advice.

 

[Merlin0728]

We are having problems with insurance denials for this issue. They request orthotics to be billed on two lines but we do not have a dx for the second orthotic.

Ex: Pt has a Morton's neuroma on the left side but no issues with the right side. Provider prescribes a pair of orthotics because you can't just use one orthotic. The patient will eventually end up with problems.
Billing L3000(Lt) G57.62 and L3000(RT) ?dx. The insurance company will not accept an unspecified dx G57.60.

Does anyone have any suggestions on how to get the insurance company to process and pay?

Thank you!

 

[CodingKing]

We are having problems with insurance denials for this issue. They request orthotics to be billed on two lines but we do not have a dx for the second orthotic.

Ex: Pt has a Morton's neuroma on the left side but no issues with the right side. Provider prescribes a pair of orthotics because you can't just use one orthotic. The patient will eventuall end up with problems.
Billing L3000(Lt) G57.62 and L3000(RT) ?dx. The insurance company will not accept an unspecified dx G57.60.

Does anyone have any suggestions on how to get the insurance company to process and pay?

Thank you!

The right side orthotic is being prescribed because of the condition on the left side so you would use the same DX for both lines.