L Code vs CPT Code 97760: Which One Do I Use?
In last weeks article, I discussed the difference between CPT codes 97760 (orthotic management and training) and 97662 (checkout for orthotic/prosthetic use). In the article, I explained how CPT code 97760 can include the assessment time, custom fitting or custom fabrication time associated with the orthosis, and the fitting of the orthosis to the patient if that time is not reported somewhere else. In this weeks article, I will discuss what the somewhere else is and when a L code may be appropriate to bill for a prefabricated, custom fitted or custom fabricated orthosis.
So if you are not counting the assessment time under CPT code 97760, where would that time be captured and billed? There are 2 possibilities. One is if the therapist bills
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Just wanted to clarify: I understood that 97760 could not be used on initial fabrication date when using L-codes for billing. Is that incorrect?
If billing a L code on a date of service, the L code payment does not include the training component. The training component would be billed using CPT code 97760.
I have a feeling I missed something. I come from a background where I was told you cannot have an initial patient encounter WITHOUT and Initial eval or assessment. But in this case with the use of L Code I could just use the L code and the code for the management and training 97760, which does include the assessment.
Thank You
Katesel Strimbeck PT, MS
In this example, yes.
Do you suggest billing the eval CPT along with 97760 if the insurance does not accept L codes from your facility?
If not billing an L code for an orthosis, 97760 would be used to account for the assessment time, custom fitting or fabrication time, fitting time and training.
I’m concerned that by billing an L code, that It will not capture the Relative Value Units to monitor productivity. Any suggestions?
How you track productivity is up to each individual organization.
Don’t you have to be a DME to bill L codes?
It depends on your setting. I wrote an article on what settings do and do not require a DME supplier number. Here is the link: http://gawendaseminars.com/2016/current-news-posts/who-can-bill-l-codes-to-medicare/
I am working with a OTR/COTA team who is covering a hand therapy clinic together. A COTA could bill 97760 for time spent on training the patient in the wearing schedule of the orthosis and exercises. But I understand the OTR would need to do the initial assessment that could be billed either with the L codes, the eval code or the ortho assess code of 97760. agree?
Yes, the occupational therapist would first have to do the assessment and/or evaluation prior to the COTA participating in the treatment of that patient.
Would either of these code be appropriate for a DME provider to use? For example, we bill L0637 with POS 11(we ship to MD office for fitting), can we bill the fitting fee without an office attached? Our MD’s do not bill the fitting fee. Are there better codes to bill with?
A DME provider would not use CPT code 97760. A DME provider would use L codes.
Can I bill an Initial evaluation and 97760 together for a Medicare patient?
You would need to check the NCCI edits to see what is and is not allowed. http://gawendaseminars.com/medicare-cms-cci-edits/
We are researching appropriate CPT codes to use for serial casting. Would you be able to comment on this? Should we use 97760/97762 or strapping codes? Thank you
For serial casting, look at the 29300 and 29400 series CPT codes.
If a patient comes in for an orthosis and therapy treatment, can you bill an evaluation, L-Code, and 97760 all in that initial encounter?
Please read this article for your answers.
I did read the article and unfortunately was still confused. CMS seems to have conflicting info from what was presented.
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56566&ver=24