June 27, 2008
Coding Instructions – Otto Bock C-Leg®
Recently during a claim review, it was noted that suppliers were billing the miscellaneous code L5999 for two functions of the Otto Bock C-Leg® lower extremity prosthesis - “continuous gait assessment, computerized MKP prosthesis” and “electronically controlled static stance regulator, adjustable.” This coding is not correct. The on-board, real-time gait analysis and stance regulation are accomplished by the microprocessors in the Otto Bock knee (code L5856). There is no separate billing and reimbursement for these functions since the allowance for these functions is included in the reimbursement for code L5856.
| According to the SADMERC, the following are the only HCPCS codes billable for the Otto Bock C-Leg®: | |
|---|---|
| L5828 | Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5845 | Addition, endoskeletal knee-shin system, stance flexion feature, adjustable |
| L5848 | Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability |
| L5856 | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type |
| L5920 | Addition, endoskeletal system, above knee or hip disarticulation, alignable system |
| L5930 | Addition, endoskeletal system, high activity knee control frame |
| L5950 | Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
Suppliers are reminded that for any questions regarding the correct coding of products to access the Durable Medical Equipment Coding System (DMECS) at http://www3.palmettogba.com/dmecs/jsp/index.jsp or contact the Statistical Analysis Durable Medical Equipment Regional Carrier (SADMERC) Coding Helpline at 1-877-735-1326.
