roxiePOD
New
I recently appealed a RAC audit for code L2114 that was orginally denied stating "documentation did not support that the billed custom-fitted item required more than minimal self adjustment at the time of delivery in order to provide an individualized fit, and included a detailed description of the modifications necessary at the time of fitting the orthosis to the beneficiary (i.e., the item must be trimmed, bent, molded (with or without heat), or otherwise modified resulting in alterations beyond minimal self-adjustment, as required.
the description for code L2114 - Ankle foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
fitting of the item was documented as well as no adjustments that needed to be made.
Has anyone dealt with a similar situation before ? I know code L4386 would describe more of the actual denial reason but not the code that I used so I'm wondering what exactly they are looking for in the audit.
the description for code L2114 - Ankle foot orthosis (AFO), fracture orthosis, tibial fracture orthosis, semi-rigid, prefabricated, includes fitting and adjustment
fitting of the item was documented as well as no adjustments that needed to be made.
Has anyone dealt with a similar situation before ? I know code L4386 would describe more of the actual denial reason but not the code that I used so I'm wondering what exactly they are looking for in the audit.
L4386- prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Last edited: