preparatory prostheses
Karl Entenmann
Description
Collection
Title:
preparatory prostheses
Creator:
Karl Entenmann
Date:
12/29/2011
Text:
Hello esteemed colleagues,
When I provide a preparatory BK prosthesis, I usually do co-ply over a lightly modified cast model, using L5530. Occasionally, I'll have to laminate one over a model, using L5540. I have one state insurance group in WA that tells me that I should do either a plaster socket, molded to model, L5510, or a thermoplastic, direct formed, L5520, instead. They want me to do this because it is less costly than thermoplastic, molded to model, and, in fact, I don't even need to get a authorization for L5510 or L5520, but I do need to get pre-authorized for L5530 or L5540, and I have to explain why I can't do the cheaper ones. It's been years since I've done a plaster prep, and I would be quite surprised if anyone does either a plaster socket over a model or thermoplastic direct formed, but that is my question. Does anyone in our profession still do either plaster over model or thermoplastic directly over patient? Also, is there any information
available from Medicare showing how many units of a specific L code were billed for any given year? I'd like to find some information to help reduce our need to get these pre-authorized, and the only way I can is to show them that these are obsolete or rarely done procedures.
Thanks for your help, and happy new year to all.
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA
When I provide a preparatory BK prosthesis, I usually do co-ply over a lightly modified cast model, using L5530. Occasionally, I'll have to laminate one over a model, using L5540. I have one state insurance group in WA that tells me that I should do either a plaster socket, molded to model, L5510, or a thermoplastic, direct formed, L5520, instead. They want me to do this because it is less costly than thermoplastic, molded to model, and, in fact, I don't even need to get a authorization for L5510 or L5520, but I do need to get pre-authorized for L5530 or L5540, and I have to explain why I can't do the cheaper ones. It's been years since I've done a plaster prep, and I would be quite surprised if anyone does either a plaster socket over a model or thermoplastic direct formed, but that is my question. Does anyone in our profession still do either plaster over model or thermoplastic directly over patient? Also, is there any information
available from Medicare showing how many units of a specific L code were billed for any given year? I'd like to find some information to help reduce our need to get these pre-authorized, and the only way I can is to show them that these are obsolete or rarely done procedures.
Thanks for your help, and happy new year to all.
Karl Entenmann, CPO
Preferred O and P
Federal Way, WA
Citation
Karl Entenmann, “preparatory prostheses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/233130.
