Re: L2780
Wil Haines
Description
Collection
Title:
Re: L2780
Creator:
Wil Haines
Date:
4/18/2018
Text:
Dear Colleagues and Guests:
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.
Wil Haines, CPO
On 4/16/2018 4:07 PM, Bryan King wrote:
> List Members:I am looking for any specific information regarding coverage for L2780 (Non-corrosive finish); has Medicare put out additional details pertaining to justification for use of this code? In my experience, it has been difficult to get reimbursed for this code. Incontinence? Working in a setting where there is exposure to caustic materials? Others? I appreciate any feedback.Bryan King, CPOJAS
>
>
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.
Wil Haines, CPO
On 4/16/2018 4:07 PM, Bryan King wrote:
> List Members:I am looking for any specific information regarding coverage for L2780 (Non-corrosive finish); has Medicare put out additional details pertaining to justification for use of this code? In my experience, it has been difficult to get reimbursed for this code. Incontinence? Working in a setting where there is exposure to caustic materials? Others? I appreciate any feedback.Bryan King, CPOJAS
>
>
Citation
Wil Haines, “Re: L2780,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/208868.
