7E9 Hip Jo
oint
Cod
ding an
nd Billing Tips
Revised: January 1, 2017
SUGGESTED CO
ODING1
Ottob
bock intendss to apply forr a new Heallthcare Comm
mon Procedu
ure Coding System (HCPC
CS) code to d
describe
the M
Meridium microprocessor-controlled foot and ank
kle system. Until we havve new codin
ng for the Meeridium,
we reecommend using
u
the folllowing misceellaneous co
ode to describe it.
L599
99
OTTO
OBOCK 7E9 HIP
H JOINT, MONOCENTR
M
RIC, HYDRAU
ULIC SWING AND STANC
CE PHASE CO
ONTROL,
INDE
EPENDENTLY
Y AND INDIV
VIDUALLY ADJUSTABLE FLEXION AN
ND EXTENSIION RESISTA
ANCE.
BILL
LING TIPS FO
OR THE MIS
SCELLANEOUS CODE – L5999
L
Narrrative Sectio
on on the HC
CFA 5010 Cllaim2,3
Beca
ause L5999 is an unlisted
d (NOC) codee, the claim must
m
have ad
dditional info
formation to describe thee item. This
will a
allow the payer to underrstand what you
y are billin
ng for. Most p
payers requiire a narrativve be added tto the claim
(e.g. description,, manufacturrer, name & model#,
m
seriial number#,, and MSRP). Please checck with your software
vend
dor and payeer for to confiirm narrativee placement..
Whe
ere to Put th
he Narrative
Electtronic Claim
Notes can
n be added in
n 3 places in the ANSI X1
12N, version 5010A1 form
mat electron
nic claim;
the 2300 Segment, the SV101-7 Segment,
S
and
d the 2400 N
NTE 02 Segm
ment. The 230
00 segment
pertains to
t the entire claim.
c
The SV101-7 and 2400 NTE 0
02 segments pertain to ea
ach line
item. Notee: Segments are limited to
t 80 charactters each (in
ncluding spacces).
2300 Seg
gment:
(In
nsert information here ab
bout the oveerall device yyou are billin
ng for).
Ex
xample:
LL
L HD PROSTH
HESIS WITH
H 7E9 HIP JT, C-LEG KNEE
E, TRIAS FOO
OT
SV101-7 Segment / 2400 NTE 02 Segment:
nsert information here sp
pecific to L59
999)
(In
Ex
xample:
L5
5999 OTTOB
BOCK 7E9 HIP JT, MONOC
CENTRIC, HY
YD SNS CTRL
L, INDIV ADJJ FLEX &
EX
XT. MSRP $_
____________
_
Papeer Claim
bmitting a h
hand-written paper. Inclu
ude the
Enter the entire narrattive on Line 19 when sub
00 line numb
ber (1-6) that the L5999 is located on
n.
HCFA 150
Ex
xamples:
LL
L HD PROSTH
HESIS WITH
H 7E9 HIP JT, C-LEG KNEE
E, TRIAS FOO
OT; LINE 1: O
OTTOBOCK
7E
E9 HIP JT, MONOCENTRIIC, HYD SNS CTRL, INDIV
V ADJ FLEX & EXT. MSRP
P $______
Ottobock
328 4058
800 3
profeessionals.otto
obockus.com
1
7E9 Hip Jo
oint
Cod
ding an
nd Billing Tips
Revised: January 1, 2017
Notee: If a narrativ
ve is not inclluded, the reequired inforrmation is exxpected to bee attached to
o the claim. IIf there is
no narrative or attachment yo
ou will receive a letter reequesting thee required in
nformation. G
Generally, sttandardized
narra
atives enablee carriers to recognize
r
sim
milar claims and assign p
pricing, therreby improviing the proceess.
NUFACTURE
ER SUGGEST
TED RETAIL
L PRICE (MSR
RP)4
MAN
2017 MSRP for th
he 7E9 is $15,834
MBURSEMENT AMOUNT
T
REIM
The rreimbursemeent methodo
ology for miscellaneous codes
c
is geneerally stated in your conttract with thee payer.
Misccellaneous co
odes are som
metimes referred to as Nott Otherwise C
Classified (N
NOC), Not Oth
herwise Speccified (NOS)
or No
on-Assigned
d codes. The most
m
commo
on methodologies are:
•
•
•
•
•
MSRP minus ___%
Cost pluss ___%
Usual and Customary
y (average am
mount that you
y bill for sim
milar devicees)
Average Regional
R
Am
mount billed for
f similar devices
Lesser of the above
It is h
highly recom
mmended to carefully rev
view your con
ntract with th
he payer wh
hen providing
g a miscellan
neous coded
prod
duct. If the in
nformation iss not in your contract, pro
ovider relatioons may be aable to help.
MED
DICAL REVIE
EW
Sometimes codess requiring narratives
n
aree sent to Med
dical Review
w regardless o
of proper claim submission. If this
pens, you will need to su
ubmit all docu
umentation (including p
proof of mediical necessityy and reason
n for
happ
repla
acement) as the claim wiill likely undergo medica
al necessity reeview.
NCLUSION
CON
Follo
owing these instructions will help you have a more successfu
ul outcome. F
For additiona
al reimbursement
inforrmation, or iff you have questions abo
out this mateerial, please ccontact Otto
o Bock Reimb
bursement att
800.328.4058 orr you can em
mail your queestion to reim
mbursement9
[email protected].
Ottobock
328 4058
800 3
profeessionals.otto
obockus.com
2
7E9 Hip Jo
oint
Cod
ding an
nd Billing Tips
Reviised: Septem
mber 28, 20
016
Referrences
Thee product/dev
vice “Supplier” (defined as an O&P pracctitioner, O&P
P patient care facility, or DM
ME supplier) assumes full
respo
onsibility for accurate billing of Ottobocck products. It
I is the Supp
plier’s responssibility to deteermine mediccal necessity;
ensurre coverage criteria is meet; and subm
mit appropria
ate HCPCS coodes, modifieers, and charrges for serviices/products
delivvered. It is alsso recommended that Supplier’s contacct insurance p
payer(s) for ccoding and co
overage guida
ance prior to
subm
mitting claims. Ottobock Coding Suggestiions and Reim
mbursement G
Guides are bassed on reasona
able judgmen
nt and are not
recom
mmended to replace
r
the Su
upplier’s judg
gment. These recommendat
r
tions may be subject to revvision based o
on additional
inform
mation or alpha-numeric sy
ystem changees.
1
Noridian Health
hcare Solutio
ons, DME MA
AC Jurisdictio
ons A & D. Miscellaneous HCPCS C
Codes Requiree Additional
Inforrmation.
2
CGS, DME MAC Jurisdictions
J
B & C. Inform
mation Requirred on Claimss for Miscellaaneous Health
hcare Commo
on Procedure
Codin
ng System (HC
CPCS) Codes.
3
The manufacturer’s suggested retail pricing
g (MSRP) is a suggested rettail price onlyy. Ottobock ha
as provided th
he suggested
MSRP
P in the event that third-party and/or fed
deral healthca
are payer’s req
quest it for reimbursement purposes. Thee practitioner
and/o
or patient carre facility is neither
n
obligatted nor requirred to charge the MSRP wh
hen submittin
ng billing claiims for thirdpartyy reimbursemeent for the pro
oduct (s).
Ottobock
328 4058
800 3
profeessionals.otto
obockus.com
3
©2016 Otto Bock HealthCare LP ● 7E9 BillingTips_02077
4