How To Integrate DME Into Treatment Protocols

Author(s): 
By Josh White, DPM, CPed

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.

Pertinent Tips On Conservative Care For Tarsal Tunnel Syndrome

Tarsal tunnel syndrome. Possible diagnosis codes for this condition are 726.79 for tarsal tunnel syndrome or 719.47 for pain in the joint, ankle or foot.

   At the initial visit, DME options are the GameDay (Ossur) or Exoform (Ossur), both of which have the possible HCPCS code of L1906.

   At the follow-up visit, consider a non-pneumatic walker (with a possible HCPCS code of L4386) for severe cases. One can also cast custom orthoses.

In Conclusion

Increasingly, solo DPMs and small groups of practioners are collaborating with large group practices. Increased size offers greater negotiating power with third-party payers as well as cost efficiencies that come with size. Such an approach also offers greater opportunity to streamline treatments to deliver optimal care in the most cost-effective manner.

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