97760 modifier?

[JADAMS71]

Anyone have any luck with getting 97760 paid for a Podiatrist? I have searched the threads on the forum. Medicare denied without a modifier saying missing modifier. Added modifier GP. Denied again for invalid or missing modifier. Any suggestions?

 

[podcoder70]

Is this being billed for custom functional orthotics or an AFO?

Assuming your DPM dispensed the AFO, the reimbursement for time spent dispensing and fitting an AFO as well as how to break it in and use it and how to care for it is included in the reimbursement for the AFO itself.
The 97760 can be billed if an orthotist dispensed the device but gave no training nor fitting, which would be a very rare occurrence. In my experience, this is not a code a Podiatrist uses.

Since custom orthotics are not covered by Medicare, ALL services/treatments from dispensing to adjustments would be cash pay.

 

[JADAMS71]

Is this being billed for custom functional orthotics or an AFO?

Assuming your DPM dispensed the AFO, the reimbursement for time spent dispensing and fitting an AFO as well as how to break it in and use it and how to care for it is included in the reimbursement for the AFO itself.
The 97760 can be billed if an orthotist dispensed the device but gave no training nor fitting, which would be a very rare occurrence. In my experience, this is not a code a Podiatrist uses.

Since custom orthotics are not covered by Medicare, ALL services/treatments from dispensing to adjustments would be cash pay.

We are not billing for the AFO, the company that supplies them bills for them. The DPM is billing for making the adjustment. I am wondering if that should be included in the E/M? Would you count additional time for the E/M for this?

 

[podcoder70]

Be very careful with this, make sure the documentation really supports the extra time. Since Medicare lumps all adjustments etc into the cost of the item, they could come back on you if audited and the documentation is not robust enough. An e&m would be more appropriate than the 97760, but with that said, charging more than a 99212 for an adjustment may not be appropriate either. This is a very touchy area. Codingline through the APMACRC has several lengthy discussions on this, I would recommend reading those to make a decision.