At Last! An Online O&P Coding Resource
By Kathy Dodson, AOPA Senior Director of Government Affairs

A large part of accurate reimbursement depends on using the correct codes, but the choice of what codes to use is not always easy or clear. AOPA fields hundreds of calls each month, and many involve how to code various devices. Well, help is here at last, in the form of an online resource called LCodeSearch.com that is available 24 hours a day.

This new AOPA service, which debuted at the 2007 National Assembly, is available to all AOPA member companies for free. Now let’s walk through the program, to show you just what it can do for you.

Getting started
If you haven’t yet signed up for this valuable member benefit, here’s how:

•    Visit www.LCodeSearch.com and scroll down to the “Log In” section on the lower left side of the screen. Select “Register” and follow the on-screen directions to sign up. You can make up your own user name and password, so you don’t need to contact AOPA to begin. In addition, unlimited users from one member company can sign up, so your whole staff can have access to the service.

•    Once you have registered, AOPA will verify that your company is a member; you will then be approved to use the site. Approval usually takes two to three days. If you try using the system and are not allowed in, don’t create a new user name and password, since doing so will simply slow down approval. Instead, e-mail Daniel Gurley at dgurley@aopanet.org, and he will be able to tell you the status of your approval.

•    Once you have registered and are approved, simply enter your user name and password in the “Log In” section of the Web site. You will be taken to a disclaimer screen, where you must click “I agree.” Once this happens, you’re in and can make full use of the system.

The main screen
Once you log on to www.LCodeSearch.com, you will see the opening screen. The center of the screen, labeled “Product Search,”  is divided into three sections. The top left section allows you to search by L code, the bottom left section allows you to search by manufacturer, and the right section allows you to search by area of the body for either orthotics or prosthetics.

Below the “Product Search” box are two other boxes, the “Patient Worksheet” section on the left and the “Medicare Allowable Lookup” on the right. We’ll get to those further on. But for now, let’s continue with “Product Search.”

Product search
LCodeSearch.com lets you find proper coding for devices and components in one of three ways: by code, by device or by location on the body.

1. Search by code
 Let’s say that your prosthetic patient is a K3 and you want to use an energy storing foot, L5976, but you are not sure which one. If you enter L5976 in the box under “Search by L Code” and click “Go,” you will get a list of feet that meet the criteria for L5976, in alphabetical order by product name. At press time, there were 14 different feet listed that would be billed under this code.

You can also use the drop-down menu to select the code you want. Whether you type in the code or select it from the drop-down box, you will notice that the full HCPCS descriptor shows up in a box located under the basic description.

The list of applicable prosthetic feet will include the product name, the manufacturer name, the L code, the category (i.e., lower extremity,) and a column headed “Details.”

You will also see that some product names are in bold, while others are not. The bold text indicates that you can click on the item name, or the “Details” button, for a more detailed explanation of the device, which may include a picture, a full description of the device and what it does, and anything else that the manufacturer wishes to display. You will also see a link that takes you directly to the manufacturer’s Web site.

You may also see listings that are not in bold type. In such instances, the manufacturer has chosen not to provide additional information beyond the product name.

2. Search by manufacturer
When you know that you want a specific manufacturer’s device, but you aren’t able to remember the exact name, or you know the name but still need the code, you can search by entering the manufacturer’s name in the “Search by Manufacturer” box or by using the drop-down menu to select a manufacturer and then clicking “Go.”

This will bring up a list similar to that in the previous example, except that instead of displaying only devices that meet code L5976, it will display all devices listed under the manufacturer you chose, in alphabetical order by product name. Scroll down to the one you want and note the appropriate code to use, listed in the third column.

If the device needs more than one code to properly describe it, multiple codes will be listed, meaning that you would bill all of those codes together.

3. Search by location
The final way to search for a code is by body location. For example, let’s say that you know you want a TLSO code, but you are not sure which manufacturer’s device you want to use, or what code to use. In this case, you would use the skeleton figure on the right of the screen.

First click on “Orthotic,” and the skeleton will turn to face backwards and will highlight several areas of the body that correspond to various orthotic devices. Click on “Spinal” and a list of all spinal codes will be displayed, along with the products that meet that code, sorted in name order.

Who makes coding recommendations?
Now you know how to find codes in LCodeSearch.com. But who decides which codes go with which devices? There are three sources that the program uses as input.

The primary source is manufacturers, who submit suggested codes when they enter a device into the system. However, before the code is accepted, AOPA reviews the manufacturer’s recommendation, comparing it with the recommendations of the AOPA Coding and Reimbursement Committee, and with the SADMERC product classification lists, which legally take precedence over any other code decisions. If the manufacturer’s recommendation disagrees with either of these sources, AOPA changes the code to a more appropriate one.

The second source of input for LCodeSearch.com is the SADMERC product classification lists. SADMERC creates and maintains these lists through its decisions on manufacturer’s requests for code determinations. Manufacturers submit a device to SADMERC, which decides on the appropriate code for billing Medicare. Once this decision is made, the assigned code must be used for Medicare billing, and the use of other codes for the device will be denied.

AOPA reviews these lists monthly and updates LCodeSearch.com with any new decisions. Even if AOPA disagrees with a SADMERC coding decision, SADMERC’s decision must be used until such time as AOPA or the manufacturer can persuade SADMERC to change its decision.

The final source of coding is the AOPA Coding and Reimbursement Committee. As this standing committee makes decisions, it adds the new codes to LCodeSearch.com’s database.

Other functions of LCodeSearch.com
The program can assist you with other searches besides coding. By clicking on “Go” under “Patient Worksheet” on the main screen, you can access a function that allows you to print out a listing of all the codes used for a particular device, along with a patient’s name, address, prescription, diagnosis and the practitioner’s name.

In addition, by entering a code and your state in the “Medicare Allowable Lookup” box at the bottom right of the main screen, you can find out Medicare’s allowable for that code. This function is also displayed on the left hand side of the screen during product search.

And finally, if you want to display all orthotic or prosthetic codes, scroll all the way to the bottom of the main screen and click on “Download Complete L Codes List” for orthotics or prosthetics.

This site will constantly be updated by both manufacturers and AOPA, so if you can’t find something, check back at a later date. If you find that you are interested in a specific product that continues to be unlisted, give that manufacturer a call and ask them to update their information.

We think you will find the site increasingly useful as time goes by. However, as AOPA members, remember that you also have access to coding and billing information by contacting AOPA government relations staff, either by phone or e-mail. You can find a listing of all staff here.

For more information, contact Kathy Dodson at kdodson@aopanet.org, or (571) 431-0810, ext. 210.

Kathy Dodson is the senior director of government affairs for the American Orthotic & Prosthetic Association (AOPA). Questions? Call (571) 431-0810 or visit www.AOPAnet.org.