Q: I recently billed for a low back support using the code 99070. The claim was rejected because the code supposedly was invalid/nonspecific. Which code should I be using?
A: When billing for durable medical equipment such as supports, pillows, braces and related items, the codes to identify those items should be coded under HCPCS (Health Care Common Procedure Coding System) codes. These HCPCS codes are very specific to the type of support or equipment being prescribed, and each item has its own special code. Code 99070 is a generic and nonspecific code for supplies and materials and does not distinguish any specific item, such as a lumbar support. While code 99070 was acceptable many years ago, insurance carriers are now requiring more specific coding that will directly identify the item.
HCPCS codes are implemented and provided by the American Medical Association and are universally used by all insurance carriers. In addition to durable medical equipment (e.g., orthoses, supports, canes, crutches, bath and toilet aids, beds, safety equipment, monitoring equipment, restraints, traction equipment, wheel chairs, etc.), HCPCS also has codes for drugs, dental services, pathology, medical services, and medical and surgical supplies. The HCPCS codes are encompassed in their own text, separate from the Current Procedural Terminology (CPT) code book. For a chiropractic practice, the most commonly used HCPCS code sections relate to durable medical equipment as well as orthotic devices.
Specifically, to answer your question regarding a lumbar support, the code you should have used and now can rebill with is L0625, which is described as a flexible and prefabricated lumbar support. If it is a similar support but is designed for the lumbosacral spine, the code would be L0628. Pricing of the item will be based on its cost and is set about 50 percent above the cost of the item. (Note that items which require fitting and training should also be billed for that part of the service with the CPT code 97760 - orthotic management and training).
Some other common codes are E0190 (positioning pillow or wedge, any type); this would include a cervical pillow as well as lumbar support pillow. A soft cervical collar is L0120; a rigid cervical collar is L0140. A foot "orthotic" that is custom-fitted to the patient's foot is L3030.
Given that these codes encompass many devices and supports, you may indeed need to have the entire text. However, I have found there are approximately 40 HCPCS codes commonly used by the chiropractic profession; I will e-mail this list upon request. I do not claim that this list is complete or a replacement to having the HCPCS text, but it may indeed bridge the gap and serve the needs for the items from your office. For a copy of this list, e-mail me at sam@hjrossnetwork.com and ask for the HCPCS list.
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