Health Information Management

Tip of the week: Coding and charging for orthotics and prosthetics

APCs Insider, April 4, 2008

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Orthotics and prosthetics can be billed by a facility with or without a durable medical equipment (DME) license. However, many facilities miss these reimbursable supplies because they are under the impression that they are required to obtain a DME license in order to bill them.

You can find orthotic and prosthetic guidance in Chapter 20 of the Medicare Internet Only Manual 100-04 (Claims Processing Manual).

In section 40, this source states that:

    SNFs, CORFs, OPTs, and hospitals bill the fiscal intermediary for prosthetic/orthotics devices, supplies, and covered outpatient DME and oxygen.

The revenue cycle management committee should review its hospital chargemaster to ensure that orthotics such as Philadelphia collars, foam cervical collars, knee immobilizers, air casts, and other supplies are defined as an orthotic per the "L" HCPCS code section of the HCPCS Level II Manual.

The facility should inventory these items and ensure that they are included within the chargemaster and that emergency department staff members charge for them.

(The above tip was excerpted from the April issue of Briefings on APCs)



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