How To Master Billing For Orthotics

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Can It Be Beneficial

The modification of orthotics is also a
common occurrence in the office. One
may need to replace or adjust top covers
and posts. Often, podiatrists may need to
adjust the curvature of the orthotic as
well. Physicians can return these devices
to the fabricating orthotic lab for adjustments.
This will obviously require a certain
amount of turnaround time.
Being able to make adjustments in the
office promptly can be an added feature
that you can offer your patients. The
materials required are relatively inexpensive.
You can bill the patient directly
for these services.
The offsetting factors are being able to
modify the orthotic device at the time of
the visit or possibly the next day rather
than having a week or greater turnaround
time in having to send the device
back to the orthotic lab. One may also
note to the patient that the fees charged
by the orthotic labs can be quite expensive.
Indeed, the patient may appreciate
the more prompt and less expensive
services that you can render. This is an
excellent practice builder as well.

Anthony Poggio, DPM

A Guide To Coding For Specific Services
Casting. There is no specific CPT code for casting for orthotic devices. It is recommended to use the unlisted casting code 29799 for this purpose. Bill this code once. However, your claim form should clarify what you are including within this code. It includes both the professional component of obtaining a mold as well as cast supplies. It is inappropriate to use A4590 or A4580 as this would imply that you used an entire roll of plaster/synthetic material to obtain this mold. Generally only a few strips of plaster are required so these codes would not be appropriate.
There is also no code for scanning orthotic devices. There is no professional component to scanning for an orthotic device as a machine does this. Most insurance companies are not currently paying for this technology.
Gait analysis. Another code that practices commonly bill with orthotics is coding for gait analysis. The CPT code 96000-96004 is for computerized gait analysis. There are many machines on the market that offer “computerized gait analysis.” This code specifically states that this test needs to be done in a dedicated facility that utilizes full 3-D capabilities with cameras mounted at multiple angles to assess gait.
One would use this code when evaluating patients with conditions such as cerebral palsy. In this instance, one would need to assess gait from all angles. On the other hand, one would not use this code when it comes to observing the gait of a patient who has been diagnosed with plantar fasciitis. It is best to bill gait analysis as part of the E/M service.
Range of motion studies and muscle testing. You must document the medical necessity and reasonableness of each of these tests. Is there clinical evidence of any muscle weakness to warrant muscle testing? Is there a history of neurologic damage or other systemic diseases such as multiple sclerosis that might affect muscle weakness? If the patient simply has biomechanical abnormalities, then this test is of questionable value and medical necessity.
Ranges of motion studies imply a complete extremity examination. This involves assessing hip, knee, ankle and foot function. Is it medically necessary to evaluate the entire leg when dealing with a limited foot condition? You must document the rationale to validate performing these tests.

Medical Necessity: When Does It Come Into Play For Multiple Pairs And Orthotics In Diabetic Shoes?
Multiple pairs. You should also develop office protocols for the fabrication of multiple pairs. Many carriers will only allow for a single pair of orthotics over a designated timeframe. However, there are patients who require different shoe gear as part of their normal job activities. There will be more of a medical necessity component and it is worth appealing to the carrier.This is in comparison to a patient who wants multiple orthotics to accommodate various styles of shoes/activities. Many labs will keep the orthotic mold on file for many years such so all it takes is a phone call to obtain second pairs. Consider an office policy with a discount for multiple pairs as there is very little office work required in comparison to the initial orthotic fabrication.
Diabetic shoes/orthotics. These are only covered when there is documentation of diabetic neuropathy, ulcerations, etc. A patient with diabetes who simply needs an orthotic for a musculoskeletal component, such as plantar fasciitis (without the associated risk factors), would still not be covered.


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Anonymoussays: December 7, 2009 at 8:37 am


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Anonymoussays: February 16, 2010 at 5:46 pm

Great Article. We have been using the L3030 code across the board as our doctor says its what we need to do. We bill the initial E/M code along with the L3030. When the patient returns to pick up the orthotics, we don't charge. I know we are loosing money; what is a better description of L3030 -Why is a plaster/cast mold not L3030? What material is for L3030?

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