How To Maximize Patient Outcomes With DME

Author(s): 
By William N. McCann, DPM

      The use of durable medical equipment (DME) has grown to become a part of almost every podiatric practice over the last half-century. In fact, podiatrists have led the field in this important area of patient treatment through our use of orthotic devices.       With our extensive background and training in biomechanics, our understanding of diabetes and its complications in the lower extremities as well as a need to provide patients with immediate immobilization, it is no wonder that DME is one of the more important offerings that we can extend to those we treat. Durable medical equipment is a critical piece of many treatment protocols due to its ease of use, patient acceptance and ability to maximize outcomes. Practically speaking, integrating DME into existing treatment protocols will improve and diversify your practice revenue stream.       Durable medical equipment is defined as items of medical equipment owned or rented that are placed in the home to facilitate treatment and/or rehabilitation. DME generally consists of items that can withstand repeated use. These items are primarily and customarily used to serve a medical purpose, and are usually not useful to a person in the absence of illness or injury. Durable medical equipment items can be custom or non-custom.       Most surveys show that podiatrists nationwide are now participating in therapeutic shoe and insole dispensing for their patients with diabetes. However, fewer DPMs are dispensing items regularly to their patients for sprains, fractures, tendonitis, unstable foot and ankle deformities, postoperatively or for offloading wounds. To maximize your patients’ outcomes, you will need to consider adding some or all of these items to your DME program. As a prescribing practitioner, you should contact your local insurance carriers, Medicare or Medicaid to verify billing codes, regulations, guidelines and fees relevant to your geographic area.

Understanding The Basics Of Common DME Coding

      Here is a list of DME common to podiatric medicine and their respective codes:       • Gauntlet-style ankle braces, prefabricated (L1902)       • Multiligamentous ankle support, prefabricated (L1906)       • Pneumatic ankle braces (L4350)       • Non-pneumatic walking boots (L4386)       • Pneumatic walking boots (L4360)       • Plantar fascia night splints (for plantar fasciitis or plantarflexion contracture of ankle joint) (L4396)       • Added depth shoes (A5500)       • Heat molded, non-custom orthotics (A5512)       • Custom orthotics (L3000-L3030)       • Custom amputation filler orthotic (L5000)       • Custom articulated hinge AFO (L1970, L2820)       • Custom solid AFO (L1960)       • Custom Gauntlet AFO (L1940, L2820, L2275, L2280)       • Collagen wound dressing (A6021)       • Foam dressing, wound cover (A6212)       • Gauze-impregnated hydrogel for direct wound contact (A6231-A6233, A6242-A6248)       Most insurers reimburse DME. Medicare, which handles these devices through one of four Durable Medical Equipment Regional Carriers (DMERC), requires a separate provider number in order to submit claims. While compliance is a critical element of participation in DMERC, the specifics of dispensing any of these items to a compliant patient cannot be completely covered within the scope of this article. However, there are Internet resources available to educate you and your staff on current Medicare regulations as they apply to the DME you dispense. Here are some resources to consider:       • www.medicarenhic.com (Region A)       • www.adminstar.com (Region B)       • www.palmettogba.com (National Supplier Clearing House and Region C)       • www.noridianmedicare.com (Region D)

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