Re: Initial foot for a new amputee (US Medicare concerns)

Re: Initial foot for a new amputee (US Medicare concerns)

Benveniste, David Mark

1/23/2006

This was a response I recently received per my post on prescribing a
foot the pt will ultimately walk on rather than a sach foot initially.

This is a perspective from the US billing angle and addresses the
potential problem in prescribing for the USA population
My response follows the post

Mark Benveniste RN BS CP
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In brevity.....
 
Since you are with the VA system there is more latitude than others
within the Medicare system. If you were outside the VA system as a
private practice, you would be in violation of Medicare rules and
regulation. It clearly states(In the Medicare section chapters and
coding) what is and is not acceptable for a preparatory prosthesis and
established a guideline to acceptable components. Remember the
K-codes.....you have to show progression and documentation before
stepping into more dynamic and expensive components. Hence the rehab.
team and evaluation approach. As a claim review specialist (at one time)
several facilities were applying flex feet to first time amputees and
attempted to bill for these feet. All denied because no documentation
was available to determine if they were to progress to the next level of
functional capabilities. Read the Medicare guidelines and it will clear
up any questions you might have on this subject for

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 Response:

I know that I probably have more latitude in the VA system to make more
choices, however, you probably read the responses of people in the
private sector with a similar approach.
 We do not do anything at our VA other than try to optimize a pt's gait
and we do have a Rehab team approach. Again, we have no monetary
incentive to use inappropriate feet on either end of the spectrum.
I do think there has been abuse in the private sector prescribing feet
such as the Mod 3 Flex foot for people clearly unable to use it. I
assume that is changing.
 
On the other hand, feet such as the Sure flex, Tribute, Dycor feet and
others, offer more than the basic Sach and should be and, I believe, are
for K2-low K3 pts.
 
I do appreciate your perspective because there are probably a lot of
Medicare audits being done with old thinking approaches to
prosthetics, and part of the problem ,as you suggest, may be the lack of
documentation.
 
Video documentation, the ability to do simplified gait analysis, and
subjective pt input in the office, would probably help the Medicare
system and the reviewers get up to speed. Perhaps standardizing that
documentation process would be helpful to the system as a whole.
 
Another part of the problem in prescribing may be that the concept of a
Dynamic foot may be confusing/misleading.
A foot that is light weight, with a smooth roll over, and deflects with
heel contact and keel contact is desirable for most. The degree to which
these do that and the ability of the pt to benefit from it, is the
criteria for more responsive feet. At least, this is my perspective.
Shock absorption and torque absorption may or may not be needed for all
levels of amputees. Of course this may be difficult to even try on pts
to see if they will benefit in the Medicare system.
 
And finally, addressing a previous post. Some people suggested that by
giving a sach foot in the beginning, you are giving the pt initial
stability. I believe other feet are not necessarily unstable because
they have more flexibility, and secondly, a more flexible foot is more
like their original foot and may be more familiar.

Mark Benveniste RN BS CP
MEDVA Medical Center
Houston, TX
USA private practices.