Corrosion add-on

Corrosion add-on

Wil Haines

4/19/2018

Dear Colleagues and Guests:

In response to Bryan King's post, non-corrosive finish is just one more
example of misunderstandings about the profession of comprehensive
orthotics and prosthetics. Those who don't have to use devices that
cause issues with skin reactions and other disgusting factors associated
with corrosion typically don't have a clue about the importance of this
topic. From a historical standpoint, at least as far back as I go,
corrosion was always an issue. Cold rolled steel was often used for
orthopedic devices and there was always a need to prevent corrosion,
which at times was rust. Fish oil treatment with an acetylene flame was
used for cold rolled steel and, as I recall, served as an excellent
corrosion prevention remedy. Polishing was also used, but much less
effective. Nickel plating was also a common remedy. I doubt that few in
the field actually know what I am talking about. Then came aluminum.
Aluminum will oxidize in short order and leave a black residue on
everything that it comes in contact with. Krylon acrylic sprays and
other remedies are used to help with this, but of course they are short
lived. Anodized aluminum solves many of these issues, but is an
expensive process when used on a custom fabricated device. Powder
coating is also a very helpful process. But all of these processes are
expensive and add costs to the device that is being fabricated. Folks
overlook the fact that adjustments are commonly needed for most
comprehensive orthopedic devices and it is very difficult, if not
impossible at times, to prevent a fracture in the corrosion coating film
when adjustments are made and then the process of corrosion resistance
has to be done again, or at least patched up. Insurance agencies and
other payers don't know or care about these matters and look at this as
a piling on of L-Codes for reimbursement. /Unfortunately, the field of
orthotics and prosthetics has not defined with certainty what
constitutes a non-corrosive finish or process on a device. /Until that
happens, it will likely be considered a luxury item and reimbursement
will often be denied. To be honest, there should actually be more than
one L-Code for these processes. If all of the processes that are
required for comprehensive orthotic and prosthetic devices, such as
non-corrosive, ultra-light, etc., etc., which are not only required but
expected, are bundled into the original fee, the base cost for an
orthopedic device will likely double or triple. It might even go higher.
That is the track that orthotics and prosthetics is now on and when the
rubber hits the road, the physically challenged population and insurers
will suddenly have their oh-crap moment. So each time a non-corrosive
finish code is denied, it is expected that this process is built into
the base system and since that was not the case, as designed by
Medicare, the costs for base systems will likely skyrocket over time.
It's called supply and demand. So Medicare and insurance companies, just
keep on doing what you are doing..... pecking away at denying factors of
necessary orthotic and prosthetic care and their associated processes.
In time, the consequences for the consumer will be noticed and then you
will have to answer for it or start reducing your consumer insurance
fees (and your profits) because of denied services to the consumer.
Necessary O&P device corrosion resistance does not happen by itself. It
is labor intensive and requires additional fees to cover the additional
expenses. How much does today's consumer pay for an appliance repair
service call? Then how much per hour does the consumer pay for the
services after the technician figures out what's wrong? It is necessary,
but not cheap. Neither is comprehensive O&P care.

So in closing, if an insurance company denies coverage for corrosion
resistance treatment. Who is legally responsible for a problematic
infection that occurs because this part of a necessary O&P service is
denied? In a court of law, what will the answer be when the plaintiff
attorney proclaims you should have known better. Or, does it imply
that the patient cannot be serviced because insurance denies a necessary
component of comprehensive O&P care? These and other questions need to
be answered in a public forum.

Wil Haines, CPO