HCPCS Code L1845: Knee Orthosis, Double Upright, Thigh and Calf, With Adjustable Flexion and Extension Joint (Unicentric or Polycentric) Medial-Lateral and Rotation Control

## **Documentation requirements for L1845** As with any HCPCS code, you must have sufficient documentation before deciding to file a claim for this code. Here are some of the things you need to have: - The full name of the patient receiving the knee orthosis - The full name and credentials of the healthcare providers involved in assessing the patient, and the fitting and adjustments/customization of the orthosis - The patient's medical history and any relevant clinical indications and diagnoses to justify the medical necessity of the orthosis - Documentation that supports the adjustment/customization of the orthosis for the patient, and that it was done by a certified orthotist or similarly trained professional at the time of delivery - Documentation showing that the patient is still ambulatory but is exhibiting instability/other problems of the knee, or they've had recent injuries/surgery of the knee - Documentation of objective exam findings - Face-to-face encounter documentation - Standard written order (SWO) or written order prior to delivery (WOPD), and proof of delivery - Knee imaging test results (X-rays, MRIs, etc.)

## **Billing requirements for L1845** Besides the documentation requirements above, please make sure to take note of or have the following: - Applicable ICD codes for the patient's condition that justify the use of this orthosis. Make sure they're for the knee (e.g., S83.144A - Lateral dislocation of proximal end of tibia, right knee, initial encounter; M23.209 - Derangement of unspecified meniscus due to old tear or injury, unspecified knee), but if other bones have been affected as a result of an injury you can use other ICD codes as well (e.g., S72.91XA - Unspecified fracture of right femur, initial encounter for closed fracture; S72.415S - Nondisplaced unspecified condyle fracture of lower end of left femur, sequela; M84.461A - Pathological fracture, right tibia, initial encounter for fracture) - Make sure to specify that this is a prefabricated item and requires expert customization, rather than minimal self-adjustment, which may require another code. - Prior authorization. Emergency/acute situations may qualify for exception via the ST modifier and prepayment review. - The use of either the RT or LT modifiers. RT for the right knee, LT for the left. If both limbs require orthoses, submit two lines with RT and LT separately, each with one unit - Attach the KX modifier if all coverage criteria are met and documentation supports medical necessity. If criteria are unmet, but an Advance Beneficiary Notice (ABN) is signed, use GA; if no ABN, use GZ. Missing modifiers may lead to denial Please make sure to familiarize yourself with the necessary coding policies and requirements so you can follow correct coding procedures. Expect a claim rejection if you have insufficient documentation.

## **Other similar codes** - **L1846** - Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated - **L1847** - Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise - **L1848** - Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf There are so many L codes that you can utilize, such as L2750, L2780, L2810, L2820, L2830, L4002, L2390, L2425, L2430, L2750, L2780, L2810, just to mention several.