I have a patient with neuropathy secondary to spina bifida. Medicare + secondary.
He has rigid cavus feet, non-healing ulcers. I got the ulcers healed. He has all of the characteristics of a diabetic, except that he's not diabetic. Are there codes that will get custom accommodative orthotics covered? Can I use the following:
#CodeDescription1 M21.621 Bunionette of right foot
2 Q66.71 Congenital pes cavus, right foot
3 Q66.72 Congenital pes cavus, left foot
4 G60.9 Hereditary and idiopathic neuropathy, unspecified
5 Q05.7 Lumbar spina bifida without hydrocephalus
6 R26.89 Other abnormalities of gait and mobility
7 L97.511 Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin
Thank you!
I would also be very careful about using the KX modifier when billing orthoticcs. For Fee for service Medicare (and others) it means the orthotic is placed into a shoe, that is an integral part of a brace. For other insurance carriers it may meet with a rejection as unprocessable for a variety of reasons. One being that the carrier's system simply doesn't recognize the modifier. In other cases, it can only be used for PT/OT CPT codes, stipulating that the patient has met and or exceeded the treatment frequencies and you have documentation supporting additional treatment.
Thus billed with L3000 it may result in claim rejection due to HCPCS and modifier inconsistency.