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Kirstyn20

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I have some questions on certain LXXXX codes. We have never had an LXXXX code paid my DMERC-ever. What are the approved dx's to get these paid? I am thinking they have to be diabetes dx's but i'm not sure because we have never billed one of these w/ a diabetes dx. I have no problem with the A5500 or A5513 codes, but these L codes I can't seem to figure out! FYI, we had some issues getting our provider # established w/ DMERC, so we have just recently began getting payments for dos's that go back to 06 and 07! So, basically I am just being able to figure out what is approved and what is not. Feedback on ANYTHING DMERC would be so helpful!! Thank you in advance!!!:)
 
Kirstyn20 said:
I have some questions on certain LXXXX codes. We have never had an LXXXX code paid my DMERC-ever. What are the approved dx's to get these paid? I am thinking they have to be diabetes dx's but i'm not sure because we have never billed one of these w/ a diabetes dx. I have no problem with the A5500 or A5513 codes, but these L codes I can't seem to figure out! FYI, we had some issues getting our provider # established w/ DMERC, so we have just recently began getting payments for dos's that go back to 06 and 07! So, basically I am just being able to figure out what is approved and what is not. Feedback on ANYTHING DMERC would be so helpful!! Thank you in advance!!!:)
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Kirstyn,

What region do you file to? I'll be happy to look through some of your applicable LCDs tonight and see if I can help at all.
 
tammster said:
Kirstyn,

What region do you file to? I'll be happy to look through some of your applicable LCDs tonight and see if I can help at all.
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We file to jurisdiction D. I have looked at the LCD but it is very vague and does not give me "answers in writing", know what I mean? It doesn't give me any valid info really. But whaever you can find that I was not able to, that would be great!!!! Any feedback is appreciated :)
 
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For anything other than your diabetic shoes - you don't really want diabetes to be the DX attached. Instead you want it to be the actual problem (ie. plantar fasciitis, tendon contracture, etc)

L3260 is never going to pay. L3000 and L3002 have to be part of a brace, in order to pay.

But your L4360, L4386, and your L4396s should be paying (unless patient received something 'same or similar' within the past 5 years (I think is the time frame for most DME items)

L4396 won't be covered if the contracture is fixed.

If you are supplying any of the AFOs for treatment of a pressure ulcer - these will not pay and should be submitted with a GY modifier and a brief explanation in block 19: "used to treat pressure ulcer"

and of course, as of 06/01/09 - the pesky KX requirement went into effect for AFO base and addition codes

What are your most commonly billed codes?
 
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