USA - Billing L2275 summary
Ted Trower
Description
Collection
Title:
USA - Billing L2275 summary
Creator:
Ted Trower
Date:
9/4/2002
Text:
My question yesterday was as follows:
:
I'm looking at the code L2275 -Addition to Lower Extremity, Varus/Valgus
Correction, Plastic Modification, Padded/Lined .
As I read it, it could apply to the hip, ankle or knee, all it states is
lower extremity. The AOPA interpretation in Coding Pro is that it only
applies to the ankle. Is anyone using it to bill for unloader type knee
orthoses?
I have received the following responses.
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
I believe that it really was intended to be just the varus/valgus tab on an
AFO. That is based on its placement in the codes. When the original
Mediare codes were brought out, there were headings for each and every
section. If you look at the code that precedes L2275, it's painfully
appearant that it perrtains only to the ankle. Our very best friends at
Don Joy have gone a long way in bastardizing the codes maximize fees. They
are the only ones that I know of that recommend it for their Valgus/vargus KO.
I believe that AOPA is right on this one.
--------------------------------------------------------------------------------------------------------
Ted,
I have used it just for that purpose.....unloader knee braces, and it is a
reimbursed code.
--------------------------------------------------------------------------------------------------------
Ted,
I use this code as if it applies to the ankle alone. I would think if it
applied to the knee it would be addressed as (genu) varum/valgum, and the hip
as (coxa) vara/valga. I'm all ears if I'm wrong, please post your replies.
Good luck, Steve Baum, CO.
--------------------------------------------------------------------------------------------------------
Ted
Glad you posted your question.
L2275
The code is not specific to the ankle although my understanding is that is
was developed for what is sometimes known as the Sabolich modification to
an AFO. You probably recall that as an addition to the supra ankle area
where the plastic extends forward and is padded to control the varus or
valgus.
Because functionally similar modifications can be made at the foot, it has
been usedfor foot plates as well.
As far as using the code for KOs Region D says No in their policy for the
L1844 code (I believe that is the code they specifically reference, don't
know if they included L1843 also). The other 3 DMERCs have not published
similar statements. No place in any of the DMERC policies, other than
referenced in DMERC D, does it specifically address use of the code for
KOs(or AFOs, etc).
Given that many of the knee orthosis descriptors include medial/lateral
control, billing in these cases would seen redundant. If they do not say
that it is a problem, you must make sure that the modification is padded,
and the model was modified to produce a varus or valgus corrective force-as
in the descriptor.
If you are thinking about using this with L 1843 & L1844, in other thatn
region D, remember that these first described the Generation II devices. As
their allowable included the corrrective strap and the devices were ML
controling, I think you are on shaky ground. For some of the other plastic
devices, that do not state ML control it might be acceptable.
Hope this helps some -
--------------------------------------------------------------------------------------------------------
Look at the picture the pad is at the foot...not to be used elsewhere unless
you want an audit...use the kneecap medial/lateral pull code...that's for a
knee...read the description of the device on page 94a of the Coding book
A MEDIAL OR LATERAL ANTERIOR PROJECTION ON AN AFO OR AFO SECTION OF THE
ORTHOSIS TO RESIST ANKLE INVERSION OR EVERSION, WHICH PROVIDES SIMILAR
FUNCTION TO A T-STRAP ON A METAL AFO.
--------------------------------------------------------------------------------------------------------
>It was my understanding that hcfa had determined that this l-code was only
>to be used for knee bracing.
--------------------------------------------------------------------------------------------------------
Ted:
We use it with our unloader knee orthoses.
--------------------------------------------------------------------------------------------------------
yes, yes, and yes
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
There is clearly no consensus here. - Ted
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
:
I'm looking at the code L2275 -Addition to Lower Extremity, Varus/Valgus
Correction, Plastic Modification, Padded/Lined .
As I read it, it could apply to the hip, ankle or knee, all it states is
lower extremity. The AOPA interpretation in Coding Pro is that it only
applies to the ankle. Is anyone using it to bill for unloader type knee
orthoses?
I have received the following responses.
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
I believe that it really was intended to be just the varus/valgus tab on an
AFO. That is based on its placement in the codes. When the original
Mediare codes were brought out, there were headings for each and every
section. If you look at the code that precedes L2275, it's painfully
appearant that it perrtains only to the ankle. Our very best friends at
Don Joy have gone a long way in bastardizing the codes maximize fees. They
are the only ones that I know of that recommend it for their Valgus/vargus KO.
I believe that AOPA is right on this one.
--------------------------------------------------------------------------------------------------------
Ted,
I have used it just for that purpose.....unloader knee braces, and it is a
reimbursed code.
--------------------------------------------------------------------------------------------------------
Ted,
I use this code as if it applies to the ankle alone. I would think if it
applied to the knee it would be addressed as (genu) varum/valgum, and the hip
as (coxa) vara/valga. I'm all ears if I'm wrong, please post your replies.
Good luck, Steve Baum, CO.
--------------------------------------------------------------------------------------------------------
Ted
Glad you posted your question.
L2275
The code is not specific to the ankle although my understanding is that is
was developed for what is sometimes known as the Sabolich modification to
an AFO. You probably recall that as an addition to the supra ankle area
where the plastic extends forward and is padded to control the varus or
valgus.
Because functionally similar modifications can be made at the foot, it has
been usedfor foot plates as well.
As far as using the code for KOs Region D says No in their policy for the
L1844 code (I believe that is the code they specifically reference, don't
know if they included L1843 also). The other 3 DMERCs have not published
similar statements. No place in any of the DMERC policies, other than
referenced in DMERC D, does it specifically address use of the code for
KOs(or AFOs, etc).
Given that many of the knee orthosis descriptors include medial/lateral
control, billing in these cases would seen redundant. If they do not say
that it is a problem, you must make sure that the modification is padded,
and the model was modified to produce a varus or valgus corrective force-as
in the descriptor.
If you are thinking about using this with L 1843 & L1844, in other thatn
region D, remember that these first described the Generation II devices. As
their allowable included the corrrective strap and the devices were ML
controling, I think you are on shaky ground. For some of the other plastic
devices, that do not state ML control it might be acceptable.
Hope this helps some -
--------------------------------------------------------------------------------------------------------
Look at the picture the pad is at the foot...not to be used elsewhere unless
you want an audit...use the kneecap medial/lateral pull code...that's for a
knee...read the description of the device on page 94a of the Coding book
A MEDIAL OR LATERAL ANTERIOR PROJECTION ON AN AFO OR AFO SECTION OF THE
ORTHOSIS TO RESIST ANKLE INVERSION OR EVERSION, WHICH PROVIDES SIMILAR
FUNCTION TO A T-STRAP ON A METAL AFO.
--------------------------------------------------------------------------------------------------------
>It was my understanding that hcfa had determined that this l-code was only
>to be used for knee bracing.
--------------------------------------------------------------------------------------------------------
Ted:
We use it with our unloader knee orthoses.
--------------------------------------------------------------------------------------------------------
yes, yes, and yes
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
There is clearly no consensus here. - Ted
Ted A. Trower C.P.O.
A-S-C Orthotics & Prosthetics
Jackson, Michigan, USA
www.amputee.com
Citation
Ted Trower, “USA - Billing L2275 summary,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/219742.
