Part B Insider (Multispecialty) Coding Alert

Published on Fri Jul 14, 2006 PDF

Keep a watchful eye for certain line item requirements

Cam walker reimbursement is a tricky task--unless you report the proper codes and justify the medical necessity according to your carrier's policy. Your first step is to determine if coverage is available. If it is, you'll want to ensure you've properly addressed the items on your CMS-1500 form.

Scenario: You've received recent denials from your DMERC for cam walkers when you coded one unit of L4360 and attached modifier LT to indicate use on the left foot.

What to do: In addition to coding L4360 (Walking boot, pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment), you must include a diagnosis that justifies medical necessity according to your carrier's policy, such as 825.25 (Fracture of other tarsal and metatarsal bones, closed; metatarsal bone[s]).

Word of advice: Most carriers allow fracture-of-lower-limb codes 820.00-827.1 for cam walkers.

Double-check these entries: When submitting your documentation, watch out for these particular entries on the CMS-1500. When presented incorrectly, they can easily cause payment refusal.

• Item 11 (Insured's policy group or FECA number): If Medicare is the primary insurance, enter the word "NONE."

• Items 17 (Name of referring physician or other source) and 17a (ID number of referring physician): Enter the name and Unique
Physician Identification Number (UPIN) of the podiatrist who prescribes the walker.

• Item 24a (Date of service): Enter the date you dispense the walker, not the item's order date.

• Item 24b (Place of service): Enter the POS for the beneficiary's residence, not the office. If the patient lives at home, the POS would be 12 (home), not 11 (office).

• Item 33 (Physician's billing name, address ...): Enter your information here, along with your 10-digit NSC number issued by the National Supplier Clearinghouse. Your name and address also go in Item 32 (Name and address of facility where services were rendered).