Billing for O&P devices seems to get more complicated by the day. Count on “Got FAQs?” to help answer your toughest questions. This month’s column addresses your questions about submitting corrected Medicare claims, unhealthy coding for prosthetic hands, and new codes to replace L-3964 and L-3965.

question :
I recently received a handful of denials stating the required modifier is missing. I realized the claims were submitted without the KX modifier. I am new at this and do not understand how I should handle any denial I receive from Medicare. Do I need to resubmit the claim as a corrected claim using the modifier? Is there any documentation I can read that would provide me with a better understanding when I receive these denials from Medicare?

Answer :
In the case of your denial, where you are missing a modifier, you may request by telephone or fax a reopening for minor errors or omissions. This process will get your claim turned around and paid quicker than going through an appeal process. To reopen by fax, you may download the required form at www.oandp.com/link/136, fill out the form, and fax it in. Since you are in Region C, you may call 866.813.7878 if you prefer to reopen the claim over the phone. CGS, the Region C Durable Medical Equipment Medicare Administrator Contractor (DME MAC), has an American National Standard Institute (ANSI) Denial Guide, which provides a list of the denial reasons and codes. It will also guide you in the next step you need to take in order to have your claim reprocessed and paid if it is eligible for payment. This guide can be accessed at www.oandp.com/link/137

question :
I work for a provider of upper-limb prostheses in Colorado. We are starting to fit more prosthetic hands, and I am not familiar with codes for hands. Are there any added or deleted codes for prosthetic hands that I should be aware of?

Answer :
On December 30, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a publication on the correct coding for articulating digit(s) and prosthetic hands. This publication also includes two new L-Codes, which CMS added for claims effective January 1, 2012. The added codes are L-6715, terminal device, multiple articulating digits, includes motor(s), and initial issue or replacement; and L-6880, electric hand, switch or myoelectric controlled, independently articulating digits, any grasp pattern or combination of grasp patterns, includes motor(s). To access the complete publication, visit www.oandp.com/link/138

question :
We are an Alabama O&P provider and have recently received numerous denials on L-3964, and L-3965—both shoulder-elbow orthoses, mobile arm supports attached to wheelchairs. I contacted Medicare, and all they would tell me is these codes are no longer valid. Did Medicare stop paying for this type of orthosis?

Answer :
Effective January 1, 2012, L-3964 and L-3965 have been discontinued and have been transferred to other codes. L-3964 is now E-2626, wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced, adjustable. L-3965 is now E-2627, wheelchair accessory, shoulder elbow, mobile arm support attached to wheelchair, balanced adjustable rancho type. Not only is your orthosis still payable, the reimbursement has increased by 2.4 percent. The E-2626 allowable amount is $638.75, and the E-2627 allowable amount is $904.89.