Code Verification Review Requirement for Articulating Digit(s) and Prosthetic Hands
On
November 11, 2021, the DME MACs published an announcement on the coding
guidance regarding the terminal devices upper extremity. The new announcement
edited the previous guidance on the use of L6881 that was provided in November
2019. It was the auto grasp feature.
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The
addition done to the L6881 automatic grasp feature made an addition to the
electronic upper limb prosthetic terminal device. It unbundled the revision,
including L6882 and the controlling microprocessor feature.
What does This Mean?
The
joint DME MAC publication and PDAC Article mean the claims will be effective
for services dated on and after January 1, 2022. The new code verification
review also means the products that can be billed under the HCPCS (Healthcare
Common Procedure Coding System) Codes are:
• L6715
– terminal device
- Multiple articulation digits
- Includes motor(s)
- Initial issue or replacement
• L6880
– electric hand,
- switch or myoelectric controlled,
- Independently articulating digits
- Any grasp pattern
- Combination of grasp patterns
These
two and the variations under it have received the reviewed code verification,
which is mandatory while undertaking medical billing and coding. The further details
are listed in the PDAC (Pricing, Data Analysis, and Coding) of the PCL (Product
Classification List) contractor website.
It
was also mandatory for the manufacturers who have these products and are under
these categories to submit the products to verify the coding by August 31,
2021.
Manufacturers
were asked to visit the PDCA website to get the coding verification review
application. The process was easy to assist the suppliers and manufacturers
with the correct coding. The revised announcement made it mandatory code
verification by the PDCA contractor for the DME MACs (Durable Medical Equipment
Medicare Administrative Contractors) for the upper extremity devices to qualify
for the HCPCS codes.
Furthermore,
it was established that the only authority to have the ability to verify the
HCPCS Level II Coding Guidelines was CMS and the DME MACs. This factor was
specified in Chapter 3, Section 3, 3.B, and 3, 6, 2.4 for the Medicare claims
in the Centres for Medicare and Medicaid (CMS) Program Integrity Manual,
published 100-08. In the manual, it has been stated that the CMS has the
authority to manage and assign the HCPCS codes by creating, changing the code
narrative, and deleting it under 42 CFR § 414.40 and 45 CFR § 162.1002.
Any
facility needing additional information on the billing and coding of HCPCS
codes related to L6715 and L6880 can look up the publication Correct Coding –
Articulating Digit(s) and Prosthetic Hands – Revised. The edition was published
in October 2019 and is a joint DME MAC publication. It is available on both
PDAC and DME MAC websites.
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