Responses: ICD-9 for OA custom knee orthosis

Responses: ICD-9 for OA custom knee orthosis

Paul Prusakowski

6/16/2008

Thanks to everyone for the very helpful responses. I am including the
original question as well as a number of the responses. 715.16 is what was
recommended by Townsend. I have included a spectrum of other responses with
some helpful information, thoughts and links. -paul

 

 

Original question:

 

People in my office are going a bit nuts right now due to a situation
regarding billing for an OA knee brace that we had custom fabricated by
Townsend. The device fits great and is taking care of the lady's problem,
but CMS has sent us multiple denials due to Invalid Diagnosis.

 

We have used 715.6 - (osteoarthritis of knee) as well as 715.9

(Osteoarthritis) and been denied twice already.

 

Calling primary care physician has been a dead end, so it is our job to

figure this one out. Is there a more appropriate code with 2 numbers past

the decimal point?

 

I really appreciate any help or suggestions that you can provide.

 

Responses:

 

Townsend Design responded and let me know that 715.16 was the best code.

 

 

This link might help you out with getting your extra numbers after the
decimal point:

  <URL Redacted>

 

 

Get a current ICD 9 book.

 

Try 715.16 or 715.36. Both of these have worked for us.

 

Dear Paul, I have found that if you use 736.42 or 736.41 we can get paid
for a custom OA brace.

 

The question is, does your diagnosis code match the code given by the Dr. in
the paperwork he/she has filed?

 

Try www.cms.gov < <URL Redacted>> then take these paths
CMS Home > Medicare > Medicare Coverage - General Information > Medicare
Coverage Database > Search Home > Search Results > View Draft LCD

 

The Draft LCD for Knee Orthoses - Draft is DL22664 and there are many
stipulations for choosing your codes now, but relative to OA DX codes you
will find:

 

715.16OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING LOWER LEG

715.26OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING LOWER LEG

715.36OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY
INVOLVING LOWER LEG

715.96OSTEOARTHROSIS UNSPECIFIED WHETHER GENERALIZED OR LOCALIZED INVOLVING
LOWER LEG

 

 

 

 

 

Paul E. Prusakowski, CPO, LPO, FAAOP

Gainesville Prosthetics

6800 NW 9th Blvd, Suite 3

Gainesville, FL 32605

352-331-4221

(fax) 352-332-8074

 

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