Guest guest Posted March 1, 2005 Report Share Posted March 1, 2005 Use the time-based code CPT 97504 for the application of a prefabricated splint as this code does not allow for the time to design and fabricate the device. Casting and strapping codes (CPT 29105, 29125, 29126, 29130, 29131, 29505, 29515) should not be billed in addition to 97504. When billing CPT 97504, supporting documentation should include: - Rationale for use of splint - Specific type of splint used and area applied - Any complicating factors - Response of patient to treatment and education Use untimed codes CPT 29105, 29125, 29126, 29130, 29131, 29505, or 29515 when splints are custom made. Charge splinting supplies using revenue code 270. As appropriate, an occupational therapy initial evaluation may also be billed with these codes. Ann Lambert Kremer, OTR/L, MHSA, CPC Beacon Rehab Solutions PO Box 172 Portland, Maine 04112 (207 ) 650-6786 akremer@... FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 1, 2005 Report Share Posted March 1, 2005 Use the time-based code CPT 97504 for the application of a prefabricated splint as this code does not allow for the time to design and fabricate the device. Casting and strapping codes (CPT 29105, 29125, 29126, 29130, 29131, 29505, 29515) should not be billed in addition to 97504. When billing CPT 97504, supporting documentation should include: - Rationale for use of splint - Specific type of splint used and area applied - Any complicating factors - Response of patient to treatment and education Use untimed codes CPT 29105, 29125, 29126, 29130, 29131, 29505, or 29515 when splints are custom made. Charge splinting supplies using revenue code 270. As appropriate, an occupational therapy initial evaluation may also be billed with these codes. Ann Lambert Kremer, OTR/L, MHSA, CPC Beacon Rehab Solutions PO Box 172 Portland, Maine 04112 (207 ) 650-6786 akremer@... FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 Kathy, Hospitals can bill L codes to their FI on the UB-92 without requiring a DME license. Read the descriptor of the L code you are billing as the pre-fabricated ones include fitting and adjustment where the custom fabricated ones do not include the words " includes fitting and adjustment " . 97504 can be billed in addition to the L codes for the training of the patient in the orthotic and for the fitting if custom fabricated. Here is the reference from the Medicare Claims Processing Manual, Chapter 20. Read page 6. www.cms.hhs.gov/manuals/104_claims/clm104c20.pdf The payment of the L code includes the supplies and cost of the materials. On the inpatient side, the orthotics are included in the DRG payment. Hope this helps. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital www.gawendaseminars.com --- Kathy Kennedy wrote: > > > > > The recent discussion about splinting has raised > additional questions in > my facility. I am passing the following questions > on from our OT > Supervisor. Can you bill outpatient Medicare for > fabricated/custom > and/or pre-fabricated splints? We already > understand the CPT codes, but > what about the use of L-codes? Does using the CPT > code 97504 include > all the costs of materials (or the pre-fab cost of > the splint) or can > you bill for that separately? Is it okay to use the > 29xxx codes, or is > it better to stick with 97504? Can you bill > outpatient Medicare for a > lap tray as a positioning device? Do we need to > have a specific order > or a letter of justification for any of this? Will > Medicare pay for > splints and lap trays on the in-pt side (above and > beyond the flat DRG > rate)? > > > > [Non-text portions of this message have been > removed] > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State > Association with a professional workshop or course - > call us at 313 884-8920 to arrange > PTManager encourages participation in your > professional association. Join and participate now! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 Kathy, Hospitals can bill L codes to their FI on the UB-92 without requiring a DME license. Read the descriptor of the L code you are billing as the pre-fabricated ones include fitting and adjustment where the custom fabricated ones do not include the words " includes fitting and adjustment " . 97504 can be billed in addition to the L codes for the training of the patient in the orthotic and for the fitting if custom fabricated. Here is the reference from the Medicare Claims Processing Manual, Chapter 20. Read page 6. www.cms.hhs.gov/manuals/104_claims/clm104c20.pdf The payment of the L code includes the supplies and cost of the materials. On the inpatient side, the orthotics are included in the DRG payment. Hope this helps. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital www.gawendaseminars.com --- Kathy Kennedy wrote: > > > > > The recent discussion about splinting has raised > additional questions in > my facility. I am passing the following questions > on from our OT > Supervisor. Can you bill outpatient Medicare for > fabricated/custom > and/or pre-fabricated splints? We already > understand the CPT codes, but > what about the use of L-codes? Does using the CPT > code 97504 include > all the costs of materials (or the pre-fab cost of > the splint) or can > you bill for that separately? Is it okay to use the > 29xxx codes, or is > it better to stick with 97504? Can you bill > outpatient Medicare for a > lap tray as a positioning device? Do we need to > have a specific order > or a letter of justification for any of this? Will > Medicare pay for > splints and lap trays on the in-pt side (above and > beyond the flat DRG > rate)? > > > > [Non-text portions of this message have been > removed] > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State > Association with a professional workshop or course - > call us at 313 884-8920 to arrange > PTManager encourages participation in your > professional association. Join and participate now! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 Kathy, Hospitals can bill L codes to their FI on the UB-92 without requiring a DME license. Read the descriptor of the L code you are billing as the pre-fabricated ones include fitting and adjustment where the custom fabricated ones do not include the words " includes fitting and adjustment " . 97504 can be billed in addition to the L codes for the training of the patient in the orthotic and for the fitting if custom fabricated. Here is the reference from the Medicare Claims Processing Manual, Chapter 20. Read page 6. www.cms.hhs.gov/manuals/104_claims/clm104c20.pdf The payment of the L code includes the supplies and cost of the materials. On the inpatient side, the orthotics are included in the DRG payment. Hope this helps. Rick Gawenda, PT Director PM & R Detroit Receiving Hospital www.gawendaseminars.com --- Kathy Kennedy wrote: > > > > > The recent discussion about splinting has raised > additional questions in > my facility. I am passing the following questions > on from our OT > Supervisor. Can you bill outpatient Medicare for > fabricated/custom > and/or pre-fabricated splints? We already > understand the CPT codes, but > what about the use of L-codes? Does using the CPT > code 97504 include > all the costs of materials (or the pre-fab cost of > the splint) or can > you bill for that separately? Is it okay to use the > 29xxx codes, or is > it better to stick with 97504? Can you bill > outpatient Medicare for a > lap tray as a positioning device? Do we need to > have a specific order > or a letter of justification for any of this? Will > Medicare pay for > splints and lap trays on the in-pt side (above and > beyond the flat DRG > rate)? > > > > [Non-text portions of this message have been > removed] > > > > > > > Looking to start your own Practice? > Visit www.InHomeRehab.com. > Bring PTManager to your organization or State > Association with a professional workshop or course - > call us at 313 884-8920 to arrange > PTManager encourages participation in your > professional association. Join and participate now! > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 What state are you from? And what is your setting? Are you hospital based? As you might guess from the various answers on the list serve..... I do not think there is a right and a wrong answer..I think much of it depends on who your FI is. What codes have you been using and what are the results? Ann Lambert Kremer, OTR/L, MHSA, CPC Beacon Rehab Solutions PO Box 172 Portland, Maine 04112 (207 ) 650-6786 akremer@... FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 What state are you from? And what is your setting? Are you hospital based? As you might guess from the various answers on the list serve..... I do not think there is a right and a wrong answer..I think much of it depends on who your FI is. What codes have you been using and what are the results? Ann Lambert Kremer, OTR/L, MHSA, CPC Beacon Rehab Solutions PO Box 172 Portland, Maine 04112 (207 ) 650-6786 akremer@... FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 3, 2005 Report Share Posted March 3, 2005 What state are you from? And what is your setting? Are you hospital based? As you might guess from the various answers on the list serve..... I do not think there is a right and a wrong answer..I think much of it depends on who your FI is. What codes have you been using and what are the results? Ann Lambert Kremer, OTR/L, MHSA, CPC Beacon Rehab Solutions PO Box 172 Portland, Maine 04112 (207 ) 650-6786 akremer@... FAX: Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 4, 2005 Report Share Posted March 4, 2005 Tim, We use the orthotic fit/ train for adjusting a splint. Our splint charges include the cost of the material used to make them. Thanks, splinting When billing for a custom splint, if we bill a splint that our OT fabricates using the 29xxx series, should we also be billing for materials or is that included within that code? Also, if there is a follow up visit needed and adjustments are made to the splint, what would be the appropriate code? Thanks Tim Pedersen PT Clifton Rehab Looking to start your own Practice? Visit www.InHomeRehab.com. Bring PTManager to your organization or State Association with a professional workshop or course - call us at 313 884-8920 to arrange PTManager encourages participation in your professional association. Join and participate now! Quote Link to comment Share on other sites More sharing options...
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