FW: 3x10=0 knee extension splint-all RESPONSES
Randy McFarland
Description
Collection
Title:
FW: 3x10=0 knee extension splint-all RESPONSES
Creator:
Randy McFarland
Date:
1/31/2007
Text:
ORIGINAL POST
Has anyone fit the 3x10=0 and have you had any problems getting
reimbursed for it? It is basically a board with straps to pull the knee
into full extension.
Thanks,
Randy McFarland, CPO
Fullerton, CA
RESPONSES
Yep, I've got a ortho guy locally who orders them whenever he fails to
get
full extension on a patient. It is really basic and cheesy for the
price,
if you ask me. I can check tomorrow, but I think we bill it out as an
immobilizer (this puppy is BIG and will, no doubt about it, immobilize
the
patient--not just his leg.) If you need more information, feel free to
call
me at work tomorrow, where I actually have information on it, like
ordering
and billing from my staff. I can't honestly tell you it works, because
I
never see the patients after fitting. But the doc continues to order
them, so maybe they do work. Another thought would be to bill as L1830
(immobilizer) and add on L2999 for the dynamic component.
Yes we use it in our practice....after tka with some fibrosis and
stiffness
works great. Does not reimburse bill pt directly.
I have fitted and delivered the 3X10 and I did not accept assignment
because there isn't a code to match it. If you are billing a unlisted
procedure code L2999 etc. be sure to be paid first.
IF THERE IS NO L CODE YOUR NOT GOING TO BE REIMBURSED-------YOUR BETTER
OFF LETTING THE PARENT MAKE THE DEVICE THEMSELVES--------INCIDENTALLY AS
RIDICULAS AS IT MIGHT SOUND THIRD PARTY PAYERS WILL PAY SEVERAL THOUSAND
DOLLARS FOR BILAT HKAFOS TO DO THE SAME THING BUT REFUSE TO PAY FOR A
BOARD WITH STRAPS ----MAKES SENCE HUH??
You may want to try Ortho-Innovations in Rochester MN for treating knee
flexion contractures
Yes we get orders for them. We have to decline doing them. The L code
is
the code for a knee immobilizer and the cost for the device is probably
2 or 3 times greater than the reimbursement. Yes, your description of
the device is correct.
I could write a short book on my 3x10 reimbursement saga. I refused to
accept Medicares denial of this simple device that I billed
appropriately using a NOC code for about $180. I had ten claims denied
and fought it all the way to hearing with a Federal Administrative Law
Judge hearing my case. I represented myself and won. After the hearing I
asked to speak freely to the judge about the whole incident. I expressed
my anger and frustration at how these simple devices whose total value
was less than one custom device, had been denied. I was angry how much
time the battle had consumed for Medicare and myself. His only reply was
that if I were to appear before him again with the same situation he
assured me I would prevail but he could not promise that Medicare would
not and could not deny payment if I provided another 3x10 board
tomorrow.
If you choose to fight I will be happy to assist you and I believe
you will win. But is it worth the effort when Medicare chooses to not
change their policy? Not for me any more. I'm putting on the thousand
dollar brace that get paid every time. Nuts isn't it?
Has anyone fit the 3x10=0 and have you had any problems getting
reimbursed for it? It is basically a board with straps to pull the knee
into full extension.
Thanks,
Randy McFarland, CPO
Fullerton, CA
RESPONSES
Yep, I've got a ortho guy locally who orders them whenever he fails to
get
full extension on a patient. It is really basic and cheesy for the
price,
if you ask me. I can check tomorrow, but I think we bill it out as an
immobilizer (this puppy is BIG and will, no doubt about it, immobilize
the
patient--not just his leg.) If you need more information, feel free to
call
me at work tomorrow, where I actually have information on it, like
ordering
and billing from my staff. I can't honestly tell you it works, because
I
never see the patients after fitting. But the doc continues to order
them, so maybe they do work. Another thought would be to bill as L1830
(immobilizer) and add on L2999 for the dynamic component.
Yes we use it in our practice....after tka with some fibrosis and
stiffness
works great. Does not reimburse bill pt directly.
I have fitted and delivered the 3X10 and I did not accept assignment
because there isn't a code to match it. If you are billing a unlisted
procedure code L2999 etc. be sure to be paid first.
IF THERE IS NO L CODE YOUR NOT GOING TO BE REIMBURSED-------YOUR BETTER
OFF LETTING THE PARENT MAKE THE DEVICE THEMSELVES--------INCIDENTALLY AS
RIDICULAS AS IT MIGHT SOUND THIRD PARTY PAYERS WILL PAY SEVERAL THOUSAND
DOLLARS FOR BILAT HKAFOS TO DO THE SAME THING BUT REFUSE TO PAY FOR A
BOARD WITH STRAPS ----MAKES SENCE HUH??
You may want to try Ortho-Innovations in Rochester MN for treating knee
flexion contractures
Yes we get orders for them. We have to decline doing them. The L code
is
the code for a knee immobilizer and the cost for the device is probably
2 or 3 times greater than the reimbursement. Yes, your description of
the device is correct.
I could write a short book on my 3x10 reimbursement saga. I refused to
accept Medicares denial of this simple device that I billed
appropriately using a NOC code for about $180. I had ten claims denied
and fought it all the way to hearing with a Federal Administrative Law
Judge hearing my case. I represented myself and won. After the hearing I
asked to speak freely to the judge about the whole incident. I expressed
my anger and frustration at how these simple devices whose total value
was less than one custom device, had been denied. I was angry how much
time the battle had consumed for Medicare and myself. His only reply was
that if I were to appear before him again with the same situation he
assured me I would prevail but he could not promise that Medicare would
not and could not deny payment if I provided another 3x10 board
tomorrow.
If you choose to fight I will be happy to assist you and I believe
you will win. But is it worth the effort when Medicare chooses to not
change their policy? Not for me any more. I'm putting on the thousand
dollar brace that get paid every time. Nuts isn't it?
Citation
Randy McFarland, “FW: 3x10=0 knee extension splint-all RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/227863.
