Wiki Orthotics coding

[Lisa Bledsoe]

What is the correct way to code for orthotics? My podiatrist came out of residency having been told to code L3000 on the day of casting and L3000 again on the date the patient picks them up. She is using rt and lt modifiers as well as having an ABN or waiver signed (if not Medicare) and uses the GA modifier. Is she doing this right? Please help - it will be much appreciated!!

 

[TammyHF]

The L3000 through L3031 could be correct for custom orthotics depending on which type the patient receives for a quantity of 2 with LT and RT modifiers. But this should only be billed once. For commercial insurance the L3000 can be billed on the day the custom orthotics are ordered but with Medicare patients the L3000 with LT, RT, GY modifier must be billed on the day the patient picks them up to be in accordance with Medicare guidelines

 

[Lisa Bledsoe]

Thanks Tammy. Humana is telling us that the RT and LT modifiers are not allowed...and my encoder does not show these modifiers as allowed. This is the first time we have had this problem, so I think it's just Humana. Your help is very much appreciated!

 

[sune626]

I also had this problem with Humana- the customer service rep told me they need it billed with a KX modifier. This is the first time I have ever had to do that. Hope that helps!