fun with coding-3

fun with coding-3

Troy Fink, CO

I would use an L1970, and L2200 for Limited motion (1 only) as it is only one
strap.

I would not code for the supramalleolar pad (L2275) however I will frequently
put in a valgus control strap as a (T) strap and bill that as an L2270.



I use a similar instep strap with a pad for most of my peds and do not charge
for it as I do not feel comfortable coding it as a T-strap. I code on the
conservative side. Harder to get in trouble that way. I can live with less
reimbursement.
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For some reason, I cannot scroll down to the bottom of the page.



I therefore am not able to view the AFO.

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WE used your question as a coding excersize for our Orthotists. The

following is our group consensus.



1 ea. L1970 Articulating AFO

1 ea. L2200 Posterior stop, dorsi resist

1 ea. L2270 Varus/valgus correction strap

1 ea. L2275 Varus/valgus correction



Of course, you can't bill for any of these codes if they are not specified

on the Rx.
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Here is how we would code your AFO:



1 L1970 Articulated AFO

2 L2200 Limited motion ankle joints (since you have the posterior

check strap that limits the ankle joints)

1 L2275 Varus/Valgus modification, padded, lined.



Hope this helps.
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Nice looking brace Troy. If it's Medicare or BCBS, you will probably not get
paid for the extra effort.

Within Medicare guidelines this would be acceptable, and have the CMN/RX
documentation on file for support



L1970 AFO with any free motion ankle joints...any type of Free motion joint
is

           included

L2275 Varus/Valgus flange, padded/lined

L3580 Dorsal strap, instep closure (Medicare/BCBS routinely denies this
because

            brace is not attached to a shoe

L2999 NOC Dorsiflexion -stop strap on posterior.

L2999 NOC Hallux elevator pad (will probably be denied. Not a recognized
addition

           to an AFO by Medicare/BCBS )

L2999 NOC Proximal pre-tib pad and strap. (I've routinely been denied this
addition

           even with documentation. Medicare states this is to be included
with an AFO



Unfortunately, Medicare's guidelines and fee schedules are the benchmark
most insurers follow. They force you to use NOC codes, and then rarely pay even
with documentation. I've had some luck submitting photos with NOC codes when
extensive procedures were done.

Incidentally, is that a flared proximal edge I see on the cuff ?......another
NOC code......every little bit helps. I'm eager to see your responses.
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see next post for the rest of the responses