Re: (OANDP-L) More on tone reduction modifications
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Collection
Title:
Re: (OANDP-L) More on tone reduction modifications
Text:
I agree that the effectiveness of tone reducing modifications is very
difficult to evaluate. Patient selection, casting technique, custom vs.
pre-fab footplates, P.T vs orthotist footplates, modification style,
compliance, all make reliable data hard to come by. I know of no scale of
tone on which to base measurements. I also agree that this type of
modification is more easily evaluated in terms of proper anatomical
positioning. In our practice, as many AFOs are made with tone inhibitive
characteristics for spina bifida children as for those with CP. Our evidence
is of course anecdotal, but we believe that this type of AFO is very
effective for many patient/clients in terms of function, range of motion,
protection of soft tissues, and yes, even some tone reduction. The issue of
if or how to bill is another thing altogether, and really may demand case by
case consideration. I think there are many differences in how these
modifications / techniques of control are applied from practice to practice,
ranging from using a preformed casting plate and doing a smooth and pull to
meticulously custom fabricating a casting footplate and spending significant
additional time modifying the resulting mold. In many cases, additional
straps, dorsal extensions, and leveling or posting treatments are added. I
believe a case can be made that any service that requires a significant
amount of additional time, materials, or expertise can be billed for. On some
level at least, an insurer agrees. Ohio Medicaid has a procedure code: Y2271,
that is described as Addition to AFO, tone reducing.
I think this whole conversation says much about the wide range of how
(technically) things are done within the O and P field. Accurate outcomes
measurements for questions such as these may be a long time coming or never
available, and if they are, we may not like the results. It is also a fact
that the L-Code system is simply inadequate.
One more point. If you do charge for tone inhibitive modifications, there is
an excellent chance you won't be reimbursed anyway.
Do your best clinically, charge for what you feel you provided, write
everything down.
difficult to evaluate. Patient selection, casting technique, custom vs.
pre-fab footplates, P.T vs orthotist footplates, modification style,
compliance, all make reliable data hard to come by. I know of no scale of
tone on which to base measurements. I also agree that this type of
modification is more easily evaluated in terms of proper anatomical
positioning. In our practice, as many AFOs are made with tone inhibitive
characteristics for spina bifida children as for those with CP. Our evidence
is of course anecdotal, but we believe that this type of AFO is very
effective for many patient/clients in terms of function, range of motion,
protection of soft tissues, and yes, even some tone reduction. The issue of
if or how to bill is another thing altogether, and really may demand case by
case consideration. I think there are many differences in how these
modifications / techniques of control are applied from practice to practice,
ranging from using a preformed casting plate and doing a smooth and pull to
meticulously custom fabricating a casting footplate and spending significant
additional time modifying the resulting mold. In many cases, additional
straps, dorsal extensions, and leveling or posting treatments are added. I
believe a case can be made that any service that requires a significant
amount of additional time, materials, or expertise can be billed for. On some
level at least, an insurer agrees. Ohio Medicaid has a procedure code: Y2271,
that is described as Addition to AFO, tone reducing.
I think this whole conversation says much about the wide range of how
(technically) things are done within the O and P field. Accurate outcomes
measurements for questions such as these may be a long time coming or never
available, and if they are, we may not like the results. It is also a fact
that the L-Code system is simply inadequate.
One more point. If you do charge for tone inhibitive modifications, there is
an excellent chance you won't be reimbursed anyway.
Do your best clinically, charge for what you feel you provided, write
everything down.
Citation
“Re: (OANDP-L) More on tone reduction modifications,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/216018.
