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DME Medicare Rejection

Annette Posted Mon 28th of January, 2019 11:13:43 AM
Help! I submitted a claim for L1833 and I used modifier LT and NU. It is being rejected for invalid HCPCS. Also L1831 with modifier RT and NU. What am I doing wrong?
SuperCoder Answered Tue 29th of January, 2019 03:43:18 AM

Hi,

As per the CMS guidelines, A knee orthosis with a locking knee joint (L1831) is covered for beneficiaries with flexion or extension contractures of the knee with movement on passive range of motion testing of at least 10 degrees (i.e., a nonfixed contracture).

If L1831 is provided but the criterion above is not met, the orthosis will be denied as not reasonable and necessary.

 

A knee orthosis with adjustable knee joints (L1833) are covered if the beneficiary has had recent injury to or a surgical procedure on the knee.  Code L1833 is also covered for a beneficiary who is ambulatory and has knee instability due to some medical condition that support medical necessity.For codes L1833, knee instability must be documented by examination of the beneficiary and objective description of joint laxity (e.g., varus/valgus instability, anterior/posterior Drawer test).

Claims for L1833 will be denied as not reasonable and necessary when the beneficiary does not meet the above criteria for coverage. For example, they will be denied if only pain or a subjective description of joint instability is documented.

 

Please also check the below link:

>https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33318&ver=36&DocID=L33318&bc=gAAAABAAAAAA&

Thanks

 

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