CODINGLINE CORNER
02/03/2010
Query: Foot Orthotics Billed
I billed custom foot orthotics as L3000, CPT 29515 (application of short leg splint [calf to foot], and A4580 (cast supplies [e.g., plaster]). On the L3000 codes, I appended the "-59" modifier.
I received a denial stating that the modifier code does not correspond with the procedure code billed. What modifier should I be using?
Thomas Fitzgerald, DPM, Rohnert Park, CA
Response: You did not mention what insurance company you are dealing with, and whether orthotics are a covered benefit. If they are not covered, then the impression casting wouldn't be covered either. It is a good idea to contact your major payers to find out what their coverage and billing guidelines are.
Some points to consider. Billing A4580 (cast supplies [e.g., plaster]) implies that you are using a roll of plaster for application of cast (not an impression cast). Generally, any minimal supplies used are included, either in the allowance for the casting or the foot orthotics themselves.
The use of the "-59" modifier implies that you performed multiple procedures that are distinct from each other. You would not append a "-59" modifier to a supply...which is all L3000 is. You add "RT" and "LT" to each L3000 billed.
You note that you billed CPT 29515 - application of short leg splint (calf to foot) - but you are not applying a short leg splint. The use of CPT 29515 is inappropriate if you are claiming to be taking an impression cast.
Tony Poggio, DPM, Alameda, CA
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