Kenevo Microprocessor Knee Billing Tips for the Miscellaneous Codes

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1 Suggested Coding 1 The following codes apply to Kenevo L5828 L5845 L5848 L5858 L5850 SINGLE AXIS, FLUID (HYDRAULIC), SWING AND STANCE PHASE KNEE. STANCE FLEXION FEATURE, ADJUSTABLE FLUID STANCE EXTENSION DAMPING FEATURE MICROPROCESSOR CONTROL FEATURE, STANCE PHASE, INCLUDES SENSORS (K3 or above for Medicare) KNEE EXTENSION ASSIST L5999* ADDITION TO OTTOBOCK (3C60 / 3C60=ST) KENEVO KNEE, INERTIAL MOTION UNIT CONTROL FEATURE FOR INTUITIVE STANDING AND WALKING BACKWARDS. Kenevo Protector L5999* ADDITION TO LOWER LIMB PROSTHESIS, OTTOBOCK 4X840 KENEVO PROTECTIVE COVER Kenevo Replacement Battery and Charger L7367 L7368 LITHIUM ION BATTERY, REPLACEMENT LITHIUM ION BATTERY CHARGER, REPLACEMENT * It is not recommended to bill Medicare miscellaneous codes (e.g. L5999) for microprocessor knees. Billing Tips for the Kenevo Miscellaneous code - L5999 Because L5999* is a miscellaneous code, the claim must have additional information to describe the item. This will allow the payer to understand what you are billing for. Most payers require a narrative be added to the claim (e.g. device name, manufacturer, model# serial number#, and MSRP). Please check with your software vendor and payer to confirm narrative placement. professionals.ottobockus.com 1

2 WHERE TO PUT THE NARRATIVE Electronic 2 Claim Notes can be added in 2 places in ANSI format electronic claims. The 2300 NTE Segment and the 2400 NTE Segment. The 2300 NTE segment pertains to the entire claim. The 2400 NTE segment pertains to each line item NTE Segment: Insert information here about the overall device you are billing for (socket, knee, ankle, foot, etc.) 2400 NTE Segments:* Insert information here about L5999 Examples: ADDITION, INERTIAL MOTION CONTROL FEATURE ON OTTOBOCK (3C60/3C60=ST) KENEVO SN MSRP $ ADDITION, OTTOBOCK 4X840 KENEVO PROTECTIVE COVER MSRP $ * NTE 2400 segments are limited to 80 characters (including spaces) PWK 2 The 2400 Loop is limited to 80 characters including spaces. For Medicare the PWK process can be used to send the narrative as an attachment if it is greater than 80 characters. You can put more information about the repair with a PWK attachment, which may reduce denials. Each DME MAC has a PWK cover page that can be downloaded. There are no limits to the narrative length. However, it must be mailed/faxed in as soon as possible after the claim is filed, because they will only hold the claim for 7 days (if faxed) or 10 days (if mailed). professionals.ottobockus.com 2

3 PWK (continued) In the claim level PWK segment (Loop 2400), use the following data elements to identify that a paper attachment is forthcoming: Type: PWK02 Trans: BM (if mailing information) or FX (if faxing information) Attachment Control Number (ACN): This is a number made up you. Also put the same ACN number on the PWK Cover Sheet. Narrative Examples for PWK: (create an attachment and include a narrative for each line on the claim and number them to match) ADDITION TO OTTOBOCK (MODEL# 3C60 / 3C60=ST) KENEVO KNEE, INERTIAL MOTION UNIT CONTROL FEATURE FOR INTUITIVE STANDING AND WALKING BACKWARDS, SERIAL NUMBER MSRP $ ADDITION TO LOWER LIMB PROSTHESIS, OTTOBOCK MODEL# 4X840 KENEVO PROTECTIVE COVER, MSRP $ professionals.ottobockus.com 3

4 Paper Claim 3 Enter entire narrative on Line 19 when submitting a hand-written paper claim (CMS-1500). Include the HCFA 1500 line number that the NOC code is located on. Examples: Line 3: L5999 ADDITION TO OTTOBOCK (MODEL# 3C60 / 3C60=ST) KENEVO KNEE, INERTIAL MOTION UNIT CONTROL FEATURE FOR INTUITIVE STANDING AND WALKING BACKWARDS, SERIAL NUMBER MSRP $ Line 4: L5999 ADDITION TO LOWER LIMB PROSTHESIS, OTTOBOCK MODEL# 4X840 KENEVO PROTECTIVE COVER, MSRP $ 2018 Manufacturer Suggested Retail Price (MSRP) 4 Most payers discount the MSRP when they reimburse for miscellaneous codes. Your contract with the payer should include how they will reimburse miscellaneous codes. MSRP for the Inertial Motion Control Unit miscellaneous (NOC) code is $ MSRP for the 4X840 Kenevo Protector is $ How Much Will I Get Paid? The reimbursement methodology for NOC/miscellaneous codes is generally stated in your contract with the payer. The most common payment methodologies are: MSRP minus % Cost plus % Usual and Customary (average amount that you bill for similar devices) Average Regional Amount billed for similar devices Lesser of the above It is highly recommended to carefully review your contract with the payer when providing a miscellaneous coded product. If the information is not in your contract, provider relations may be able to help. professionals.ottobockus.com 4

5 s Reimbursement Team is available to help with your Kenevo claims. Phone: (ask for reimbursement) your question to: References 1 The product/device Supplier (defined as an O&P practitioner, O&P patient care facility, or DME supplier) assumes full responsibility for accurate billing of products. It is the Supplier s responsibility to determine medical necessity; ensure coverage criteria is met; and submit appropriate HCPCS codes, modifiers, and charges for services/products delivered. It is also recommended that Supplier s contact insurance payer(s) for coding and coverage guidance prior to submitting claims. Coding Suggestions and Reimbursement Guides are based on reasonable judgment and are not recommended to replace the Supplier s judgment. These recommendations may be subject to revision based on additional information or alpha-numeric system changes. 2 Joint DME MAC. Local Coverage Article: Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426). Not Otherwise Classified (NOC) BILLING INFORMATION. Updated December 21, The manufacturer s suggested retail pricing (MSRP) is a suggested retail price only. has provided the suggested MSRP in the event that third-party and/or federal healthcare payers request it for reimbursement purposes. The practitioner and/or patient care facility is neither obligated nor required to charge the MSRP when submitting billing claims for third-party reimbursement for the product (s) Otto Bock HealthCare LP Kenevo Billing Tips professionals.ottobockus.com 5