Dynamic test socket-Responses

Dynamic test socket-Responses

Randy McFarland

9/7/2006

ORIGINAL POST:
1. What do you feel is the ideal length of time to send a patient
out on a dynamic test socket?
2. How often (out of 10) do you end up making another socket before
you deliver the permanent prosthesis?
3. Should there be a separate L code for dynamic test socket
procedure?
Randy McFarland, CPO Fullerton, CA
 
RESPONSES:
1. 2-3 weeks 2. 6 3. I believe it would make sense, Currently I
use the check socket code.
 
I feel I send my Patients out longer than most. I tend to have them out
for around a Month prior to determining proper fit. I tend to do just
one dynamic socket-do my adjustments, then go to definitive.
 
I just started providing the harmony system, which includes a diagnostic
socket. This socket with the harmony system is used outside my office
(before I provide the definitive socket). A separate L code is clearly
needed for the dynamic test socket. My expectation for a new patient
and their first definitive socket; a few dynamic sockets will be
required.
 
There used to be a code for this procedure but it was deleted. I would
like to see it back and many more like it. It is getting harder and
harder to see patients. We are changing the way we fit patients to keep
inline with all the deletions. This is making it easier for other people
to do our work.
 
I have never done a test socket without test walking a patient in bars
or with sufficient protection from any break or fall and touch wood
never had any problem either. In fact in some cases I had reinforced
test socket for home use and have had no problems except one patient
whose engineer son thought that socket flexion and slight dorsiflexion
of foot was idiotic concept and he straightened the alignment like a
true engineer and had his dad trip and fall. This approach of test
walking patient and making sure socket fit is optimum gives patient an
appreciation that you are interested in his welfare and want to make
sure that every thing is alright.
I send my amputees home with their test sockets for a week. Strict
verbal instructions to use around the house only, no stairs beyond
three. Socket/attachment interface is wrapped with Delta-Lite.
Duration of comfort is the issue. Redos are less than 1-3%, really
minimal; but my comfort level is worth it. My constant is this: are my
amputees honest and really using the test socket or are they simply
trying to please me.
I generally send out for 1-2 weeks only. 50 % make 2nd.
I am continually making adjustments on a weekly basis, saying prayers
nightly that the plastic doesn't give too much (even wrapped with
fiberglass tape), and lamenting the fact that I haven't been paid a red
nickel as nothing has been delivered, despite the weekly appointments.
Luckily, that's more the exception than the rule. I don't send anyone
out on a test socket that has a history of missing appointments or not
following directions and when I do send one out, usually I get it back
within a week.
I would say I let the patient take home the test socket only 5 out of
 10--mostly people who have had problems in the past and/or new
 amputees. I let them wear the test socket until no changes need to be
 made and they've been comfortable since the last appointment. This
 varies from 3 days to 3 months. My best guess for percent of the time
 that I make another test socket is 10%. The issue of a separate code
 for a dynamic test socket is really another name for another issue:
 should we be reimbursed for our services or the device? This would be
 a long discussion.
 
1. What do you feel is the ideal length of time to send a patient
out on a dynamic test socket? No more than 1 week
2. How often (out of 10) do you end up making another socket before
you deliver the permanent prosthesis? 10 out of 10 in that the material
I use for a dynamic check socket is either thermolyn or fiberglass
reinforced PETG.
3. Should there be a separate L code for dynamic test socket
procedure? Since a check socket is about $250.00 and not intended to be
used in a dynamic situation outside of the clinical setting I would say
yes.
 
I usually try to fit the check socket without pylon first, if fit and
total contact is good after modifications I will either mount or remake,

depending on the level of modifications made. At that point I refit and

if good then reinforce with casting tape and send home for week with
instructions on use time and activities. Re-eval then finish.
 
I keep most of my digitally measured/scanned patients in check sockets
for at least a week. Hand casted ones for a day or two. I make a new
check socket about 4 out of 10 times. If any shortcomings are to be
caught, catch them in the check socket! I like to think I deliver a
finished product to my patients. If I have to grind on a new socket, I
have not spent enough time in the check socket phase. And there should
be a separate code for dynamic sockets. They cost more to make, and
require more effort to complete, especially if the socket is one
combining locking liners and air expulsion systems used in conjunction.