Molded to patient model???

Molded to patient model???

I was asked last week to consult with an elderly diabetic AKA at the Ohio
State University prosthetic clinic. This patient had a new but extremely
poorly fitted prosthesis which she was unable to wear. It was fabricated for
her by a prosthetist who came out and took some measurements and delivered
the prosthesis a couple of days later. I explained to her that a cast of her
residual limb would be required for a socket replacement and she again told me
that the other prosthetist only took measurements.
The socket (an attempt at ischial containment) was so poorly designed that the
I.T. was well above the posterior brim and the socket was internally rotated
to such an extent that the adductor longus was 2 cm. from it's channel.
My question is does this constitute fraud using HCFA guidelines? The
descriptors clearly state molded from patient model. Does CAD by the
numbers meet these guidelines?
I know is is becoming common practice for many facilities to order sockets
(and orthoses) which are measurement based and are not created from either a
custom impression or virtual casting system. In reality, I have seen some of
them fit rather well, however, It seems to me that this is not the issue
What is the feeling of the group? Does a measurement based prosthesis or
orthosis meet the molded from patient model guidelines? Do we need new L
Codes for measurement based systems?
I look forward to your response.
Ron Kidd, CPO
American Orthotic & Prosthetic Lab., Inc.
Columbus, Ohio