L3000 Denials in Texas
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A recent PM Pulse story left me baffled for an answer and wondering if other Texas (or others) orthotic providers are faced with the same issue
Despite billing the L3000 on two separate lines each with either a LT or RT modifier, the carrier is only paying for one unit.
He insists that his diagnosis code is correct, yet I am wondering if the laterality ICD10 code matches the HCPCS LT or RT code.
Another possibility is that the MUE (Medically Unnecessary Edit) which limits the quantity of a specific code can be provided on one DOS is somehow the issue. The MUE for HCPCS such as L3000 have an anatomical exception listing. And perhaps that exception of LT or Rt is being ignored.
The following coding errors are cited:
CO4: Procedure code is inconsistent with the modifier used
N519: Invalid Combination of HCPCS modifiers.
These error codes also don’t seem to be consistent with the problem, unless the ICD10 and HCPCS code don’t match up. For example, recently a new ICD10 set of codes was introduced for plantar fasciitis: M72 has been discontinued and replaced by M67.A01 for right foot and M67.02 for left foot.
Hence if only one diagnosis code is listed on the claim form for both L3000, that could be one reason for denial.
The conclusion here is that when billing for custom foot orthotics (UCB Type) or any other custom foot orthotic, it is of paramount importance to match the right ICD10 with the correct LT or RT modifier for the HCPCS code.
If you are having any of these issues, please contact your KevinRoot customer service representative. The APMA CAC meeting is in a few weeks, and if others are despite properly submitting claims, your APMA CAC/PIAC representative can assist in identifying the issues and help to resolve them. Please either contact me or APMA or KevinRoot for further advice.
