Axon-Bus® Prosthetic System (APS) –Above Elbow

Axon-Bus® Prosthetic System (APS) –Above Elbow
AxonArm Ergo, Michelangelo Hand, AxonHook, and AxonRotation
Billing Tips for the Miscellaneous Codes
Effective March 25, 2015
Table of Contents
1. Miscellaneous Code Descriptions for Axon-Bus Prosthetic System Components
2. Narrative Section on the HCPCS Claim
3. Where to Put the Narrative
4. Manufacturer Suggested Retail Price (MSRP) for the Miscellaneous Codes
5. Medical Review
6. Conclusion
Ottobock intends to apply for new Healthcare Common Procedure Coding System (HCPCS) codes to
describe the unique features of the Michelangelo Hand, AxonHook and the AxonArm Ergo microprocessor
control features. Until we have new coding for these features, we recommend using miscellaneous codes in
addition to existing codes to describe them.
1. MISCELLANEOUS CODE DESCRIPTIONS (long description)
Michelangelo Hand
L7499 OTTOBOCK 8E500 MICHELANGELO ELECTRIC HAND WITH OVAL INTEGRATED WRIST JOINT, SWITCH
OR MYOELECTRIC CONTROL; PROGRAMMABLE FOR PROPORTIONAL/DIGITAL CONTROL; ARTICULATING
FINGERS (MCP FLEXION/EXTENSION, ADDUCTION/ABDUCTION) AND POWERED MULTI-POSITIONAL
THUMB (OPPOSITIONAL, LATERAL, AND NEUTRAL GRIP PATTERNS); INCLUDES LITHIUM-ION POWER
SOURCE AND CHARGER.
AxonHook
L7499 OTTOBOCK 8E600 ELECTRIC HOOK WITH OVAL INTEGRATED WRIST JOINT, SWITCH OR MYOELECTRIC
CONTROL; PROGRAMMABLE FOR PROPORTIONAL/DIGITAL CONTROL; POLYURETHANE COATED, LIGHT
WEIGHT, HEAVY DUTY TITANIUM HOOK TIPS, AUTOMATIC RETURN TO NEUTRAL FEATURE; INCLUDES
LITHIUM-ION POWER SOURCE AND CHARGER.
AxonArm Ergo with AxonRotation
L7499 ADDITION TO UPPER EXTREMITY EXTERNAL POWERED PROSTHESIS (OTTOBOCK 12K501
AXONARM ERGO), SEQUENTIAL MICROPROCESSOR CONTROL OF ELECTRIC LOCKING
FEATURE, ELECTRONIC WRIST ROTATOR. AND TERMINAL DEVICE (SIMILAR TO L7180
WITHOUT ELBOW LIFT, WHICH IS INSTEAD PROVIDED BY THE FOREARM COUNTERBALANCE
FEATURE).
AxonArm Ergo without AxonRotation
L7499 ADDITION TO UPPER EXTREMITY EXTERNAL POWERED PROSTHESIS (OTTOBOCK 12K501 AXONARM
ERGO), MICROPROCESSOR CONTROL OF ELECTRIC LOCKING FEATURE AND TERMINAL DEVICE
(SIMILAR TO L7180 WITHOUT ELBOW LIFT, WHICH IS INSTEAD PROVIDED BY THE FOREARM
COUNTERBALANCE FEATURE).
Ottobock
800.328.4058
http://professionals.ottobockus.com
1
Axon-Bus® Prosthetic System (APS) –Above Elbow
Billing Tips for the Miscellaneous Codes
2. NARRATIVE SECTION ON THE HCFA 5010 CLAIM2
Because L7499* is an unlisted (NOC) code, the claim must have additional information to describe the item,
so that the payer can tell what you are billing them 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 for where to add the narrative.
3. WHERE TO PUT THE NARRATIVE
Electronic2
Claim
Notes can be added in 3 places in ANSI format electronic claims. The 2300 NTE Segment
pertains to the entire claim, where the SV101-7 segment and the 2400 NTE Segment apply to
line items.
2300 NTE Segment:
• Pertains to the entire claim.
•
Put information here about the overall device you are billing for (e.g. socket, knee,
ankle, foot).
SV101-7 and 2400 NTE Segments: Put information here about L7499
•
Hand: Ottobock 8E500 Michelangelo elec hand w/intgr wrist, power src & chgr
MSRP $____
•
Hook: Ottobock 8E600 AxonHook elec hook w/intgr wrist, power src & chgr MSRP
$____
•
Elbow with AxonRotation: Seq MP Ctrl of elec elbow lock, wrist rotator &
terminal device(s), sim to L7180 w/o lift MSRP $____
•
Elbow without AxonRotation: MP Ctrl of elec elbow lock& terminal device(s), sim
to L7180 w/o lift MSRP $____
SV101-7 & 2400 NTE segments are limited to 80 characters (including spaces)
Paper Claim3
Enter entire narrative on Line 19 when submitting a hand-written paper claim (CMS-1500).
Note: For multiple miscellaneous codes precede each description on line 19 with the line
item number that corresponds to the line on the CMSS-1500 that contains the NOC code.
•
Hand: Line: __ L7499 Ottobock 8E500 Michelangelo electric hand with
integrated wrist, power source & charger; MSRP $____
•
Hook: Line:__ L7499 Ottobock 8E600 AxonHook electric hook with integrated
wrist, power source & charger; MSRP $____
•
Elbow with AxonRotation: Line:__ L7499 Addition, sequential MP Ctrl of
electric elbow lock, wrist rotator, and terminal device(s); similar to L7180 w/o
lift MSRP $____
•
Elbow without AxonRotation: Line:__ L7499 Addition, MP Ctrl of electric
elbow lock and terminal device(s); similar to L7180 w/o lift MSRP $____
Ottobock
800.328.4058
http://professionals.ottobockus.com
2
Axon-Bus® Prosthetic System (APS) –Above Elbow
Billing Tips for the Miscellaneous Codes
Note: If a narrative is not included, the required information is expected to be attached to the claim. If there is
no narrative or attachment you will receive a letter requesting the required information. Generally,
standardized narratives enable carriers to recognize similar claims and assign pricing, thereby improving the
process.
4. MANUFACTURER SUGGESTED RETAIL PRICE (MSRP)4 FOR THE L7499
MISCELLANEOUS CODES
•
2015 MSRP for the Michelangelo Hand is $75,000.00
•
2015 MSRP for the AxonHook is $15,000.00
•
2015 MSRP for the Microprocessor Control Feature on the AxonArm Ergo with AxonRotation is
$30,000.00
•
2015 MSRP for the Microprocessor Control Feature on the AxonArm Ergo without AxonRotation,
is $25,000.00
5. MEDICAL REVIEW
Sometimes codes requiring narratives are sent to Medical Review regardless of proper claim submission. If
this happens, you will need to submit all documentation (including proof of medical necessity) as the claim
will likely undergo medical necessity review.
Following these instructions will help you have a more successful outcome. For additional reimbursement
information, or if you have questions about this material, please contact the Otto Bock Reimbursement
Department at 800.328.4058 or you can email your question to [email protected].
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 Ottobock 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. Ottobock 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
Billing Instructions for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Submitted with a Not
Otherwise Classified (NOC) HCPCS. NHIC Corp., DME MAC Jurisdiction A Resource. June 2013;28:87-88; Revised: Billing
a Not Otherwise Classified Health Care Common Procedure Coding System Code. National Government Services, DME MAC
Jurisdiction B. January 2014; Noridian Healthcare Solutions, LLC, DME MAC Jurisdiction D. Electronic Claim Narratives.
3
NHIC Corp. DME MAC Jurisdiction A Supplier Manual, Chapter 3, Health Insurance Claim Form, Instructions for line 24D;
National Government Services, DME MAC Jurisdiction B Supplier Manual Chapter 12, Claim Submission. Instructions for line
24D; CGS Administrators, LLC. DME MAC Jurisdiction C Supplier Manual, Chapter 6, Claim Submission. Item 24D; Noridian
Healthcare Solutions, LLC, DME MAC Jurisdiction D. Keys to Successful Claims Filing.
4
The manufacturer’s suggested retail pricing (MSRP) is a suggested retail price only. Ottobock has provided the suggested
MSRP in the event that third-party and/or federal healthcare payer’s 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).
Ottobock
800.328.4058
http://professionals.ottobockus.com
3
© Otto Bock HealthCare LP ● 11AE-APS.04252015
6. CONCLUSION