Author Topic: Orthotic and Prosthetic billing  (Read 2030 times)


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Orthotic and Prosthetic billing
« on: December 26, 2011, 07:33:13 PM »
I am working for a company that designs and fits Orthotic and Prosthetic devices.  I was asked by the owner if there is a "crosswalk" that can be used for ICD-9 (ICD-10) and HCPCS codes.  Does anyone have information regarding this type of a crosswalk that indicates if a particular diagnosis code is appropriate for the HCPCS code being used.  My understanding is the ordering physician gives the DX code when ordering a certain devise, and when billing insurance, they are receiving denials.  I am just beginning with this group and have never billed for orthotic and prosthetic devices.  Any help or suggestions?


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Re: Orthotic and Prosthetic billing
« Reply #1 on: December 28, 2011, 06:52:20 AM »
So you are looking for something that tells you if a certain HCPCS code is covered for a specific ICD-9 code?  I also understood that the dx came from the ordering physician as well, but most ordering physician's give a script with a handwritten diagnosis, not a code so it could be that the person converting the script to an ICD-9 is not using the appropriate code.  For example, the Dr may write "diabetes" but we all know that there are MANY ICD-9's for many different types of diabetes, and some codes are covered for some, but not for all.  It is important to get the right dx code.  With that being said, I am not aware of a "crosswalk" for this.  Is it one particular insurance carrier, or all across the board?  I know we have the ability to look up info like that with our local BCBS, and Medicare you can go to the LCD/NCD's.  If it is one particular carrier you could try contacting the provider rep to see if anything is available.
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