Point-Counterpoint: Do AFOs Have A Role In Fall Prevention?

Jeffrey C. Christensen, DPM, FACFAS, and Douglas Richie Jr., DPM, FACFAS

   Physicians can take a rational approach in dealing with elderly patients suffering from lower extremity sensorimotor deficiencies and fall risk by implementing a targeted multifactorial treatment plan that incorporates physical therapy and use of custom dynamic AFO devices. This can improve their patients’ balance control and quality of life.

   Dr. Christensen is in private practice at Ankle & Foot Clinics Northwest in Everett, Wash. He is the Founder and Director of the Northwest Surgical Biomechanics Research Laboratory, a division of the International Foot and Ankle Foundation for Education and Research. Dr. Christensen is a Fellow of the American College of Foot and Ankle Surgeons.



Dr. Christensen,

I am confused. You state that practitioners should "never prescribe custom braces in a prophylactic manner to prevent falls." Yet your entire article is advocating this practice?

Furthermore, are you saying that when a patient fails the Timed Up and Go test, they qualify for a custom AFO according to Medicare guidelines? I have read the Medicare guidelines for medical necessity and there is nothing about balance disorders, peripheral neuropathy or arthropathy which you state are valid diagnoses for AFO reimbursement from Medicare.

I have waited patiently for your reply to this valid challenge to your position in prescribing and billing Medicare for "Falls Prevention AFOs". Can you provide your insight and experience with billing Medicare for these devices when the medical necessity of this treatment is not justified, according to current Medicare guidelines?


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