How To Integrate DME Into Treatment Protocols

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Secrets To Effective Inventory Management Of DME

Busy podiatry practices must make efficient use of the office space available in order to manage DME inventory.

   Select products that offer an opportunity to be used for multiple conditions. Depending on the frequency of need and space allowance, consider products that one can use on the left and right foot, and that require fewer sizes. For less common conditions, establish a protocol for items to be used and the vendor that will provide the products.

   The goal of maintaining inventory is to have on hand those items that are part of the treatment protocols, in sufficient quantity and sizes, given the physical confines of the available space. The practice should maintain a certain minimum quantity of products on hand, taking into consideration the rate at which they are used and the time for delivery. If the practice consistently runs out of products before the designated reorder time, increase the minimum quantity.

   The medical assistants and physician should periodically review how well the devices are working, how much patients like them and what they can do to improve application. Consider new products, different products as recommended by others and products presented at conferences.

   It is essential to designate a person in the practice who is responsible for organizing storage areas and determining maximum and minimum quantities for all products in all sizes.

   Create a designated frequency and day when the ordering person checks inventory and orders as appropriate. The practice manager should periodically review quantities of products in stock and prices paid. Ordering can be easier via the use of customized screens on the given distributor’s website. Distributors can also help practitioners to order in a timely fashion by sending customized order forms that indicate the quantity of products to keep on hand and the price paid.

Author(s): 
By Josh White, DPM, CPed

   The medical assistant can do the initial intake. Based on an understanding of treatment protocols, the assistant can then make the DME products readily available for the physician to recommend. The physician should review the initial intake and perform an evaluation. The physician describes the plan of treatment and therapeutic objectives of DME. The medical assistant reviews the application of DME with the patient.

   When a patient’s therapeutic needs are beyond the ability of the provider, make a referral for consultation or further treatment. Consider pedorthists, orthotists and other podiatrists for possible referral. If appropriate, the medical assistant issues instructions on referral.

What About Conservative Modalities For Plantar Fasciitis?

For patients with commonly presenting foot and ankle conditions, there are a number of specific DME products that one can keep on hand.

   Plantar fasciitis. One possible diagnosis code is 728.71 for plantar fascial fibromatosis.

   At the initial visit for patients with plantar fasciitis, one may use an Airheel (Aircast), which has a possible HCPCS code of L2999. Patients may also benefit from a readymade insert such as Powerstep (Powerstep).

   At the second visit, patients may use a posterior or dorsal night splint (possible HCPCS code L4396) or custom orthoses. Consider a low top pneumatic walker for severe cases (with a possible HCPCS code of L4360).

   At the third visit for patients with plantar fasciitis, consider shockwave therapy if patients are not achieving adequate pain relief.

Recommendations On Prefabricated Products For Ankle Sprains

Ankle sprain (grade 1). Possible diagnosis codes include 729.5 for ankle pain; 719.07 for effusion of the joint, ankle or foot; and 845.02 for sprain and strain of ankle and foot, specifically the calcaneofibular ligament.

   At the initial visit, one can use an Air Stirrup (Aircast) with a possible HCPCS code of L4350. Other options include a GameDay (Ossur) or Exoform (Ossur), both of which have the possible HCPCS code L1906.

   Ankle sprain (grade 2). As with grade 1 sprains, possible diagnosis codes include 729.5 for ankle pain; 719.07 for effusion of the joint, ankle or foot; and 845.02 for sprain and strain of ankle and foot, specifically the calcaneofibular ligament.

   At the initial visit for grade 2 ankle sprains, one may prescribe a pneumatic walker with a possible HCPCS code of L4360. The DME products in this category include the SP Walker (Aircast), the XP Walker (Aircast) and the Air Walker (Ossur).

   For a follow-up visit, patients may benefit from a semi-rigid shell with compression, such as the AirSport (Aircast), with a possible HCPCS code of L1906.

   For subsequent visits, patients with grade 2 ankle sprains may use a wobble board or A60 (Aircast), which has a possible HCPCS code of L1902. Other DME products are a GameDay (Ossur) or Exoform (Ossur), which both have the possible HCPCS code of L1906.

   Ankle sprain (grade 3). This is associated with fracture and there are number of possible diagnosis codes as follows:

• 845.01 (sprain and strain of ankle and foot, deltoid ligament)
• 719.07 (effusion of joint, ankle, foot)
• 729.5 (ankle pain and support)
• 824.2 (ankle fracture, lateral malleolus only)
• 824.6 (ankle fracture, trimalleolar)
• 845.02 (sprain, strain, calcaneofibular ligament)

   At the initial visit, patients with grade 3 ankle sprains can use a pneumatic walker, with a possible HCPCS code of L4360. Durable medical equipment options in this category include the SP Walker (Aircast), the XP Walker (Aircast) and the Equalizer (Ossur).

   At the follow-up visit, one can prescribe an AFO with multi-ligamentous ankle support with a possible HCPCS code of L1906. One such AFO is the AirSport (Aircast).

   For subsequent visits, DME options for patients with grade 3 ankle sprains include a wobble board. Other options are the A60 (Aircast), with a possible HCPCS code of L1902, or the Exoform (Ossur), with a possible HCPCS code of L1906.

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