Passive Transfemoral Prosthesis Replys
Thomas Masters
Description
Collection
Title:
Passive Transfemoral Prosthesis Replys
Creator:
Thomas Masters
Date:
2/14/2005
Text:
Original MSG: A passive prosthesis is not unusual for upper extremity.
I have a request for a transfemoral passive prosthesis to be worn while
in a wheel chair in public areas.
The patient/client is not a candidate for a real prosthesis. We
intend to use pediatric components for this 96# lady.
Our problem is billing. Family would like to use Medicare. I don't
think it's legal. Vanity is not a medical justification. We don't find
any LE L-code's for such a thing? Has anyone billed one of these? How?
Thanks!
Good Responses. Thank you
Replies:
* You can bill Medicare, but your claim will be denied due to
lack of medical necessity. Have the beneficiary sign a waiver of
liability (Medicare calls it an Advance Beneficiary Notice) stating
that they will pay for it in the probable event that Medicare denies
payment. This way you get paid by them (if you are lucky) and you have
complied with their request to bill Medicare. I suspect they will change
their request after you explain they will be liable for full payment
when Medicare denies the claim. This reminds me of the six magic words
that heal almost anything: Medicare will NOT pay for it.
* Bill it as a K1 ambulator for transfers only and use the
cheapest components you can find.
* You are correct. Medicare requires at least a k1 level
potential. Self pay in my opinion.
* If she can transfer with the prosthesis she would be
considered a K1. If she can't, she is a K0. Medicare will not cover a
prosthesis in this case.
* Can she stand and do transfers with the prosthesis? If so then
you have demonstrated as use. If you do not feel comfortable, then you
could have the patient sign a Medicare possible denial. Do not take
assignment and self pay.
* I provided this type of cosmetic prostheses a few years back
for a 300lb bilateral transfem. elderly female amputee. If I recall, we
billed Medicare. I believe we contacted them and they allowed us to bill
them as reduced fees, custom fit temporary prostheses.
If this tip helps....I actually used 3/4 pvc components, lightweight
sach feet, with the knee/ankle angles set to match a visually cosmetic
appearance while in the wheelchair. The proximal foam covers were
hollowed out to meet the distal ends of the limbs. The covers were
finished and then attached to a thin lightweight foam and polyethylene,
small square base.... smaller than the dimensions of the wheelchair
seat.
This entire unit was one piece, strong and very light, heaviest being
the sach feet. In one motion, the patient could slip the entire unit
under the distal thighs...very comfortable...no pressure on the
R.L's...(not to interfere with any weight distribution or ischial
discomfort in the chair)
It could also be used in a car, or any seat in her home. Transferring
from a car to a wheelchair, and placing the limbs under her legs was
fast...took a second and easy for the family...her clothes provided the
additional finishing touches.
* Her justification is she is an amputee we should not judge
what the patient is using it for if we receive an rx. with an ICD 9
code, then fabricate and bill This lady paid into the system for over
65-70 years..basing it on working at age 16 or her husband paid into the
system..please let us help our elders they deserve it...How many AFOs do
we fabricate knowing that the patient may not walk...perhaps she will
pivot transfer...by the way if I were making it I would use pedi parts
too perhaps you may have a foot around that was used as a demo...and I
would bill frugally but I would give her what they request.
* In the UK we do do passive limbs for T/F amputees and we simply
build one from plastazote ( a pre made one is available from
Blatchfords) but sometimes we just make one up from 2 sheets glued
together..this may be a cheaper option than a component build! Hope this
is of some assistance but not the answer to your question.
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or affiliations should be used in all communications.
I have a request for a transfemoral passive prosthesis to be worn while
in a wheel chair in public areas.
The patient/client is not a candidate for a real prosthesis. We
intend to use pediatric components for this 96# lady.
Our problem is billing. Family would like to use Medicare. I don't
think it's legal. Vanity is not a medical justification. We don't find
any LE L-code's for such a thing? Has anyone billed one of these? How?
Thanks!
Good Responses. Thank you
Replies:
* You can bill Medicare, but your claim will be denied due to
lack of medical necessity. Have the beneficiary sign a waiver of
liability (Medicare calls it an Advance Beneficiary Notice) stating
that they will pay for it in the probable event that Medicare denies
payment. This way you get paid by them (if you are lucky) and you have
complied with their request to bill Medicare. I suspect they will change
their request after you explain they will be liable for full payment
when Medicare denies the claim. This reminds me of the six magic words
that heal almost anything: Medicare will NOT pay for it.
* Bill it as a K1 ambulator for transfers only and use the
cheapest components you can find.
* You are correct. Medicare requires at least a k1 level
potential. Self pay in my opinion.
* If she can transfer with the prosthesis she would be
considered a K1. If she can't, she is a K0. Medicare will not cover a
prosthesis in this case.
* Can she stand and do transfers with the prosthesis? If so then
you have demonstrated as use. If you do not feel comfortable, then you
could have the patient sign a Medicare possible denial. Do not take
assignment and self pay.
* I provided this type of cosmetic prostheses a few years back
for a 300lb bilateral transfem. elderly female amputee. If I recall, we
billed Medicare. I believe we contacted them and they allowed us to bill
them as reduced fees, custom fit temporary prostheses.
If this tip helps....I actually used 3/4 pvc components, lightweight
sach feet, with the knee/ankle angles set to match a visually cosmetic
appearance while in the wheelchair. The proximal foam covers were
hollowed out to meet the distal ends of the limbs. The covers were
finished and then attached to a thin lightweight foam and polyethylene,
small square base.... smaller than the dimensions of the wheelchair
seat.
This entire unit was one piece, strong and very light, heaviest being
the sach feet. In one motion, the patient could slip the entire unit
under the distal thighs...very comfortable...no pressure on the
R.L's...(not to interfere with any weight distribution or ischial
discomfort in the chair)
It could also be used in a car, or any seat in her home. Transferring
from a car to a wheelchair, and placing the limbs under her legs was
fast...took a second and easy for the family...her clothes provided the
additional finishing touches.
* Her justification is she is an amputee we should not judge
what the patient is using it for if we receive an rx. with an ICD 9
code, then fabricate and bill This lady paid into the system for over
65-70 years..basing it on working at age 16 or her husband paid into the
system..please let us help our elders they deserve it...How many AFOs do
we fabricate knowing that the patient may not walk...perhaps she will
pivot transfer...by the way if I were making it I would use pedi parts
too perhaps you may have a foot around that was used as a demo...and I
would bill frugally but I would give her what they request.
* In the UK we do do passive limbs for T/F amputees and we simply
build one from plastazote ( a pre made one is available from
Blatchfords) but sometimes we just make one up from 2 sheets glued
together..this may be a cheaper option than a component build! Hope this
is of some assistance but not the answer to your question.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Thomas Masters, “Passive Transfemoral Prosthesis Replys,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 25, 2024, https://library.drfop.org/items/show/224373.
