Medicare Denial
Marty Mandelbaum
Description
Collection
Title:
Medicare Denial
Creator:
Marty Mandelbaum
Date:
5/2/2018
Text:
Denial for an L1833 ROM Knee orthosis
Submitted to medicare
Rx: for L1832
Diagnoses: OA left Knee, subchondral insufficiency fracture of femur
Progress: notes indicate -
Diagnoses: fracture of tibia, medial meniscus tear, oa of left knee, closed
fracture of left fibula, suture removal and fall initial encounter
*left positive McMurray test,* tenderness over medial joint line, varus
alignment, patella crepitus- modrrate, good stability, ant drawer test
negative.
Device receipt for L1833 ( L1833 is the crossover code for 1832, that is
what I supplied because it did not need extensive modification.)
All material dated prior to billing date
Additional addendum from doc Knee brace hinged L1832 ordered, Knee MRI
viewing subchondral fracture med femoral condyle and tib plateau.
What else could be possibly needed to justify the payment for this
orthosis, am I missing something or is there enough justification in the
notes as is for this orthosis?
Marty Mandelbaum CPO, FAAOP
Submitted to medicare
Rx: for L1832
Diagnoses: OA left Knee, subchondral insufficiency fracture of femur
Progress: notes indicate -
Diagnoses: fracture of tibia, medial meniscus tear, oa of left knee, closed
fracture of left fibula, suture removal and fall initial encounter
*left positive McMurray test,* tenderness over medial joint line, varus
alignment, patella crepitus- modrrate, good stability, ant drawer test
negative.
Device receipt for L1833 ( L1833 is the crossover code for 1832, that is
what I supplied because it did not need extensive modification.)
All material dated prior to billing date
Additional addendum from doc Knee brace hinged L1832 ordered, Knee MRI
viewing subchondral fracture med femoral condyle and tib plateau.
What else could be possibly needed to justify the payment for this
orthosis, am I missing something or is there enough justification in the
notes as is for this orthosis?
Marty Mandelbaum CPO, FAAOP
Citation
Marty Mandelbaum, “Medicare Denial,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/208927.
