Outpatient Documentation

ICD-10 codes

diagnoses have _

• combination of letters and numbers

• Codes begin with a letter and have six or seven places. The first three places are the category, the second three refer to category, anatomic site or severity and the seventh place is used to indicate stage of encounter or sequela. Not all codes require a seventh character

CPT codes or L codes

interventions have _

• current procedural terminology

• numbers only

• Ot eval & interventions

characters 3-7

_ are alpha OR numeric 

alpha 

1st character is _ 

(all letters used except U are used) 

• not case sensitive

numeric

2nd character is _

A

Inital encounter for closed fracture

B

Inital encounter for open fracture

D

Subsequent encounter for fracture with routne healing

G

Subsequent encounter for fracture with delayed healing

K

Subsequent encounter for fracture with nonunion

P

Subsequent encounter for fracture with malunion

S

Sequela

30

Low Complexity (97165) requires _ minutes

45

Moderate Complexity (97166) requires _ minutes

60

High Complexity (97167) requires _ minutes 

1 unit

8-22 minutes

2 units

23-37 mins

3 units 

38 to 52 minutes

4 units

53 to 67 mins

5 units

68 to 82 mins

6 units

83 mins

L Code Billing

• Not Time-Based!

• The L code includes evaluation, base components and parts, fabrication and fitting.

• If the therapy prescription is for a comprehensive evaluation for therapy and treatment as well as for an orthosis, then the evaluation CPT code (97164-97167 for OT or 97161-97163 for PT) and L code may be billed together as long as the orthosis is included in the written treatment plan.

• If a prescription is for an orthosis only, then only the L code should be charged, and the evaluation CPT code should not be charged

reimbursement for orthotics: L-code 

• The description following the code indicates the joints covered or influenced by the orthosis

• (S=Shoulder, E=Elbow, W=Wrist, H=Hand, and F=Finger) followed by the letter O for Orthosis.

• They are also described as without joints (static) or with non-torsion joints, elastic bands or turnbuckles (dynamic)

• prefabricated (P/F), off the shelf (OTS) or custom fabricated (C/F)

time-based

CPT codes are _