L2275 Responses. Long Read But Quite Interesting

L2275 Responses. Long Read But Quite Interesting

KEITH SMITH

12/7/2011

So the question was brought up in our month
ORIGINAL POST FROM 12/7/11

So the question was brought up in our monthly orthotic meeting of whether we
should add the code L2275 to our smo base code L1907 when we are using them for
correction of varus or valgus. Currently, we use just the L1907 only, but what
stimulated the question was the recommendation of its use with the sure step
system. I was always under the assumption that this code was for the sabolich
padded tibial flare trim. I noticed that surestep's website even recommends 2 of
these 2275 on each smo.

All responses and thoughts are greatly appreciated and will post them without
author. Thanks in advance,

Keith M Smith CO LO FAAOP

Responses are all listed below.  So there is some passion on both sides which
further emphasizes the ambiguity in the code itself.  After reading the
responses, I decided to also consult AOPA on the code.  They said that there has
been some increased recent inquiry into this code from the membership in the
last couple of weeks and so it therefore should make the agenda of the Coding
Committee's next conference call.  For now, my personal take is that I am going
to wait to get an official ruling from AOPA's  coding committee.  With there
being multiple interpretations of the code I think it best to see what the
committee thinks. I have cc'd AOPA as well here so that they have the responses
for the call as well.  Again. I have to emphasize that this listserve is such a
valuable tool for information.  Thanks to all who responded. 

Keith M. Smith CO LO FAAOP

RESPONSES IN THE ORDER THEY CAME IN

Contact Bernie at SureStep for the comprehensive answer. My advice is to NOT add
those codes to what you are fabricating in-house unless made exactly like the
SureStep version. 

I've never used them for the Sabolich trim, and use them on all AFOs. I don't
bill two, but I can see the justification. I believe the picture in the
Illustrated Guide shows an ST mod, not the Sabolich trim.

You can use the code not only for the Sab trim but for modifying your cast to
correct varus/valgus. All codes are recommended and if you can justify them you
should be in the right.
 
Bernie Veldman sent me verbiage (attached) to use when billing these codes.
I have had trouble with them getting denied as duplicates. The insurance
companies tell me they are appropriate and payable, but get kicked out as
duplicates. We are working with them and Opie to decide whether to bill one
of them as a miscellaneous code or change the L2275 in Opie to be a variable
code, which allows us to change the description, i.e. dorsal wings for
forefoot valgus control.
 
In our clinic, we use L2275 any time we take a cast and are actively correcting
varus/valgus or are making the modification in the plastic; we also use it for
any external heel posting that is for v/v control. In the case of a
by-measurements SureStep SMO, my coworkers and I use the following coding:
L1907, L2275, L2999 for any transfer/pattern. The liner/pads and straps are
included in the base code L1907.
 
That is pushing the envelope too far. Just because it is on a website does not
mean that it is ethical or legal. After all, the website will always have their
disclaimer which puts the onus on the practitioner and not on them. And two on
one subtalar joint, come on.

 
Just because you CAN use it doesn't mean you SHOULD use it. We bill
SMOs with L1907 only. If you add an internally routed strap, adding
L2270 is appropriate.
 
Keith I do not agree with SureSteps use of the L2275 code for SM AFOs
and do not use it. I do use them fairly regularly. I only use this
code on patients that I have to work at controlling the varus/valgus
issue. I do use heel seats on any AFO/UCB that is used in weight
bearing in ambulation. If they are going into a stander I do not add
it
 
It was my impression that L2275 referred to any varus or valgus correction in
the modification of the cast. I have used them with AFOs, and KAFOs, but never
with a SMO. It didn't seem to be warranted with that type of orthosis. I do not
currently use this code at all anymore. I was under the impression it was
falling out of favor with Medicare due to misuse.

 
 
 
 
 
 
 
 



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These days I often take L-code recommendations by vendors with a grain of salt.
They often are not accurate. I fear that some companies merely wish to sell us a
product. I will take them if I know the company well and they seem to take care
in the L-codes they recommend to us.

I'd say use the L2275 with the L1907 (SMO):


* tibia and fibula are engaged with the calcaneus within the orthosis to
control varus/valgus

* requires very intimate fit to provide control using force over a very limited
surface area, i.e. numerous adjustment appointments

* we DO NOT get reimbursed for our time, so we must make it up in our device
codes, esp if we are looking to get results
This is the exact reason Medicare cuts the additions. End result is those that
truly bill when they are used no longer get paid for the additions. Exactly what
occurred with the arizona afo. Promote use of codes for intended use. Gray area
is common, but this is not a gray area.

 
Just because the trim lines are anterior shouldn't automatically allow you to
use two. Is it varus or valgus you are correcting? Both? Probably not. Use it
once.
 
We bill for L2275 for forefoot control. We don't bill for 2 as surestep
suggests, but on AFOs with the Sabolich modification AND FF control, we'll bill
for 2. I believe the coding committee for AOPA has approved this.

I agree that it is confusing and that maybe there should be a different code for
FF control.
 
Interested to see responses. We do use 2275 when appropriate but only one per
brace when we do use.

 
Excellent question! I took the academy coding seminar about five years ago and
they clearly stated that the L2275 should only be used for sabolich type trims
on molded afos. My former employer sent out a memo stating they wanted all
practioners to use the L2275 on every molded afo. When I questioned there memo
they told me that because I am correcting the position of varus or valgus of
foot that this is a plastic modification. I disagreed

We have debated these codes as well at our facility.
Ultimately some practitioners believe that the sabolich trimline w/
padding is the only reason to use the L2275, and some believe that
almost any intrinsic varus/valgus correction that is padded applies.
2011 HCPCS L2275
Addition to lower extremity, varus/valgus correction, plastic
modification, padded/lined
I personally feel that devices that are predominately designed to
address a varus/valgus deformity have this included in their base
price. To me that is the SMO, the UCBL, Ritchie Braces, and Arizonas.
Solid ankle AFO's, KAFO's etc that do not primarily address
varus/valgus condition would then be used with the L2275.
Ultimately, SureStep doesn't promise you that the device will be
reimbursed on those codes.
 
Very Very risky since the ear tabs don't provide any varus, valgus support since
you can't push on the malleoli. I would not want to defend that one at audit.
Remember the payer will audit you not the manufacturer. It's not like the person
or entity recommending the L-code is going to write the check for the penalty.

 

 SureStep Response: I should begin by clarifying that we do
not recommend codes, but only suggest them. (Apparently, there is some legal
difference), and that ultimately it is the responsibility of the coding
practitioner and practice to code in an ethical manner and in a way that
they are comfortable and confident. That said, this is a great topic of
discussion that I feel many clinicians in our field are leery of addressing.
Although we are a manufacturer, we also have several clinical practices, all
of whom fit SureSteps as well as Cascade SMOs and more traditional style
SMOs. This was for a long time a topic of great discussion amongst our
practitioners and our own internal coding committee.
While you are correct in stating that it was originally the Sabolich
trimline that generated this L2275 code, it is not limited to that specific
modification. What would be the difference if you trimmed to control varus
and valgus at the lower tibia or at the knee or at the foot? My point is
that there can be many varus and valgus modifications made to a custom
orthotic device and that we as clinicians should not be expected to eat all
extras that we design and fabricate into an orthosis. We have been pretty
successful at making the case for the uses of these codes with both private
payers and with state Medicaid programs. Although not everyone pays for all
of the units, we do fight for them whenever it is feesible to do so. Once
we establish the precedent with one payer, we then try to use that as
leverage as well. We have been very open about what we use the codes for
and how we justify their use.
I hope that this is helpful and if you do need some help with verbiage,
please let me know and I can send you some that we have successfully used.
Recently, there has been more opposition to this and the fight is definitely
getting tougher. But, that is even more reason to continue the fight.
As a side note, we are trying to get HCPCS codes established for some of
these modifications, so that they are not all lumped into one code. This
would also eliminate the over usage of the L2275 code.