Re: Socket Changes.

Re: Socket Changes.

Marty Mandelbaum

9/3/2001

Question-
What are the facilities using as guidelines for TT or TF socket changes?
>Do you wait for a certain number of inches, sock plys or percentage in
>reduction?
>Is time also part of the consideration?
>Are these billable and if yes what codes are typically used?
>Thanks for your reply.
>Marty Mandelbaum CPO

Answers-
I am aware of no fixed guidelines regarding socket replacement. In my
practice I have found it most practical to replace sockets when the amputee
is wearing 13 to 15 ply of sock. This seems to be the point at which
additional socks do not improve overall comfort or function.
I bill for replacement sockets on preparatory limb regularly. I do not
have any difficulties or fixed minimum time intervals. Some third party
payors balk if socket replacements are too frequent but what else is new?
I code for the replacement socket (L5700 for a bk) a liner and end pad.
Ted A. Trower C.P.O.

Marty, Yes you may be reimbursed for socket changes IF they meet certain
criteria--- refer to your DMERC supplier manual page 182.3 and use that as
a standard for most of your insurance companies and ALWAYS document & MD Rx.
Good luck, Mike

Marty - My general rule is when the fit gets to 10 plies or the patient
loses control of the prosthesis (it starts rotating at heel strike), then a
new socket is indicated. The base codes for socket changes are:
L5700 - BK socket change, L5704 - replacement BK cover
L5701 - AK socket change, L5705 - replacement AK cover
these base codes INCLUDE the attachment plate but you have to add the codes
for test socket(s), total contact, ultralight material (if you use carbon
braid in your lay-up), ischial containment etc. If you are using a locking
liner, the patient probably needs two new, smaller ones so add the L5667 &
L5669. Check the condition of the socks, sheaths and shrinkers to see if
new ones are needed. Bill Arrowood, CP

The methods vary according to the individual, of course, but generally I
use 10-12 sock ply as an indicator for the patient to return for
evaluation. If they are still comfortable and happy, then I advise them
of the changes occurring and tell them to return when any discomfort
occurs. At about 15 ply, I recommend a change and use anatomical
changes and volume reduction on the LMN. I have had new amputees
(usually younger and very active) proceed from 2 ply initially to almost
20 ply within a couple months. And this is starting 4-6 weeks post op.
I've never had a problem with insurance covering the socket replacement.
(Knock on wood)
Some matured amputees don't necessarily change in volume as much as in
shape and the time frame is generally much longer. If they start
developing a problem 2-3 years after delivery that I cannot associate
with overuse or change of footwear, etc., then I assume anatomical
changes are the culprit and usually recommend a socket change. And
usually, this resolves the problem. So, yes, time is indeed a
consideration.
As far as billing, there is a specific REPLACEMENT SOCKET code. I add
the additions of IC modifications, flex inner/rigid outer frame, total
contact, etc. as indicated.
Hope this has been helpful.
Joan K. Cestaro, C.P.

Dear Marty,
    We replace sockets billing under L5700 and L5701 codes. It varies on
when this is done. We often replace the socket on an old temp when a
patient has worn out their definitive ( so def. becomes back up). Cover is
also billed as replacement in this case. We have also done replacement
sockets on temps when the patients shrink a great deal quickly. We wait at
least 1 month between in these cases. If you would like more info, just let
me know. I am sure you will get interesting replies on this. Teri
Powers-Watts, CPO,CPed

Hey Marty,
I don't bill temps. I do a deffinitive prx and then bill socket changes.
It's
fewer headaches for me, the patient get's acclamated to their deffinitive
components without having to change around and actually is cheaper for 3rd
party payor. I take circumferences everytime a patient is in the office so
that documentation is there if my actions are ever questioned. A letter of
med neccessity doesn't hurt either. Most of my stuff is medicare and
according to the HCFA manual, changes are warranted and paid for if there
has
been any type of physiological or anatomical change. I have billed socket
changes to Blue Cross as little as 1 month after prosthesis was delivered
and
had no problem (patient went from liner only fit to 20 ply;and yes they were
in a shrinker). The main thing to remember is document, document, document.
There is a code for socket replacement and new cover which is also
indicated.
I am at home right now so I can't tell you what it is. But let me know and
I
will be happy to discuss.
Paul Meyer, CPO