Earlier this summer the DME MACs and PDAC together announced new coding verification requirements. Starting January 1, 2021, any products that are billed using L5856, L5857, L5858, L5973, L5980, and L5987 must have been reviewed by PDAC and listed on their Product Classification List. What does this mean? It means the way we code some of our favorite lower limb prosthetic products is changing. Our manufacturers have worked to ensure products that are in those coding buckets are on the Product Classification List. At the same time, it is up to you as a business owner to ensure your team practices these changes now or you could face reimbursement delays, denials, and/or partial payment issues. 

One way to stay proactive when it comes to these current coding changes is to continuously review and update your common coding selections in your EMR system. I recommend clinics review their internal coding selections at least every six months to safeguard against improper coding practices. However, this process only helps you at one stage in the RCM process. How do we build in a checks and balance for both our clinical team and our billing team?

The next step is to build a product guide, which creates a mechanism of transparency for your team. Creating a comprehensive product guide that includes all the products your team typically orders will create product awareness for every department and serve as a best practice guide for coding. This can be a daunting task, so just start with prosthetic feet for now. Not only does a guide like this help practitioners, but it also becomes an educational tool for billers.  Additionally, it is a great training tool for residents, who may not be as familiar with coding.

Let’s walk through the steps to create your own product guide. You don’t need a fancy tool for this—excel is my preferred tool—but use what you have and keep it simple. Below is a starting point for how to build this guide. Start with these basic columns and fill in the sheet with your high-volume prosthetic feet products.

• Recommended Columns:
• Product Name
• Vendor
• K-Level
• LCodes
• Cost
• Margin
• Notes

Depending on time constraints, building something like this could take a team anywhere from a couple of weeks, to a few months. It depends on how many products you include or if you add other areas like knees, liners, or upper extremity prosthetics. Once you get started, you will figure out what is needed based on the use of the guide.

Once you have a good starting point, put the guide into action. Give it to your entire team to use. Next, set a one-month follow-up meeting with your team to review the use of the guide. Take their feedback and continuously improve. When this guide is in maintenance mode, you will have a resource that helps to ensure proper coding, while providing cross-functional education.

Jessica Norrell, CPO, MBA | MOZN Solutions | Contact us today for help!

Written for the Q1 2021 Publication SPS Xpress