Q/A: I Billed 2 Units of L3020 and Claim was Denied. Why?

by  Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
Aug 13th, 2019

Question:

We billed 2 units of L3020 but were denied for not using the right modifiers. What should we do?

Answer:

Rather than submitting two units of the L3020 to indicate that the patient one orthotic for each foot, you would need to use modifiers identifying left foot and right foot. Appropriate coding for this would take 2 line items of data entry to appear appropriately on the claim form. The correct way to code for this is:

L3020-RT
L3020-LT

RT is the appropriate modifier to identify procedures performed on the right side of the body and LT is the appropriate modifier to identify procedures performed on the left side of the body. And of course, be sure that you have appropriately diagnosed to support medical necessity for this supply in the patient documentation and on the claim form.

You can also reference complete definitions of these modifiers (RT & LT) in your current year ChiroCode DeskBook.

About Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC

Brandy is a Certified Professional Coder (CPC), Certified Medical Compliance Officer (CMCO), ChiroCode Certified Chiropractic Professional Coder (CCCPC), a Certified Professional Compliance Officer (CPCO)and a Certified Professional Medical Auditor (CPMA). She is also the President of CHelpDesk Solutions (www.CHelpDesk.com), chiropractic's on-demand Certified Virtual Chiropractic Assistant.

Brandy is a member of the AAPC (American Academy of Professional Coders), PMI (Practice Management Institute), and the ACA (American Chiropractic Association).