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Deciding on the right code for splint fabrication?

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Vol. 16 •Issue 1 • Page 13
Coding Clues

Deciding on the right code for splint fabrication?

Q: Many therapists are debating whether to use L codes or CPT code 97760 for splint fabrication. Can you tell me the correct way to go? I realize L codes encompass materials, labor and revisions. My concern is reimbursement for materials using the 97760 code. Historically, this has been a supply code.

A: The answer depends on the insurance carrier, and if the carrier reimburses for L codes billed under a physical and/or occupational therapy plan of care. Providers of therapy services who submit claims to fiscal intermediaries under Medicare Part B benefits can bill and be reimbursed for L codes without requiring a durable medical equipment (DME) license. Providers include hospitals, comprehensive outpatient rehab facilities, outpatient rehab facilities, skilled nursing facilities and home health agencies that provide outpatient therapy services at home. Providers can bill for the appropriate L codes on the UB-92 claim form, along with other therapy services they're billing during that claim period.

Suppliers of physical and occupational therapy services provided under Medicare Part B benefits require a DME license in order to bill and receive reimbursement for custom fabricated orthoses. If they have a DME license, they can submit the claim for L codes to the durable medical equipment regional carrier on a 1500 claim form. Regarding non-Medicare payers, suppliers and providers of therapy services must verify if the insurance company reimburses for L codes and bills under a therapy plan of care, and if the supplier or provider has a DME license.

CPT code 97760 was a new CPT code in 2006; it's not a supply code. The description for 97760 is: Orthotic management and training (including assessment and fitting when not otherwise reported), upper extremity, lower extremity and/or trunk, each 15 minutes. Management may include assessing the patient for need and type of orthosis, range of motion measurements and manual muscle testing, assessing sensation and grip strength testing. Management also may include the design, fabrication and fitting of an orthosis. In addition, code 97760 includes the training provided to a patient regarding use of the orthosis during activities of daily living and other functional activities.

If a supplier or provider bills for an L code, they only bill the appropriate number of units of 97760 for the time spent on the training component; the L code reimbursement includes the assessment, design, fabrication and fitting time, and supplies used to fabricate the orthosis. If an insurance carrier doesn't accept L codes from a supplier or therapy provider, these entities can handle billing under code 97760.

L codes reimburse better than the appropriate number of units of 97760 for assessment, design, fabrication and fitting time. L codes describe the type of orthosis that a physical or occupational therapist fabricated for the patient. Suppliers and providers of therapy services should always bill the codes that best describe an intervention, regardless of reimbursement, and make sure documentation supports the billing of their codes.

Rick Gawenda, PT, is director of physical medicine and rehabilitation at Detroit Receiving Hospital in Michigan. He conducts national seminars on coding and reimbursement, along with other topics. If you have a tough coding issue you can't crack, e-mail shuelskamp@merion.com. To read more coding suggestions, go to www.advanceweb.com/REHAB and click on the Coding Clues tool bar.


 

Hi Rick. I have taken your classes before and am on your email blast list. We had a Medicare patient come in today for hand splints that the PT made for her. How can we bill for this? I have never used an L code. How does that work? Where does it go on the bill? How does billing this way compare to billing units of 97760?
Thank you for your help.
Susan

Susan Robertson,  Biller,  Reynolds Rehabilitation EnterprisesOctober 27, 2014
Eagan, MN



Can you bill for more than 1 L code in the same treatment visit?

Jennifer Stump,  OTApril 20, 2012
TN



I am having a problem billing Medicare with L codes we are an ORF and bill on a UB04 (old UB92 form) Most of them are splints for hand and wrist. I think the occurance code and reveune code is where my error in billing is. I need help and Medicare is unwilling to provide any information. Help

Jennifer Shepard,  billing agent,  Bollettieri Sports MedicineFebruary 07, 2012
Bradenton, FL




     

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