Replace foot/ Build New Prosthesis- Billing responses

Replace foot/ Build New Prosthesis- Billing responses

Paul Prusakowski

1/4/2012

Thanks for your replies. I think that the route that I am going to take is
to replace the broken foot with a new version of the same type. This will
solve the immediate needs. (The foot came off easily for those who were
concerned about potential disasters). I will fabricate a new prosthesis for
the patient and when it is complete use the NEW foot from the old prosthesis
and then find another foot that the patient can purchase out of pocket as a
backup foot. This simplifies billing, simplifies the patient's life, and
just rides out my credit card payments longer J Of course the patient will
need to go to the MD and have them do 75 tests and document everything
before fabrication can begin.

 

 

Original question:

I am working with a new patient who recently moved down from the frozen
northern part of the country. The patient wears an old exoskeletal
prosthesis that he has been wearing for about 10 years, but the foot is
basically destroyed and is in need of replacement. The patient has a Rx for
replacement of foot as well as a Rx for a new prosthesis because the old
prosthesis, although functional, has seen much better days and has been well
worn.

Replacing the foot is a no brainer, but since I will be starting work on a
new prosthesis soon, I want to make sure that I code appropriately so that I
do not end up creating an issue for myself down the line.



The patient has Medicare as insurance.

My initial thoughts are using L7510 (Repair of Prosthetic Device, Repair or
Replace Minor Parts) and L7520 (Repair Prosthetic Device, Labor Component,
per 15 minutes) for the work I am doing right now. But, I question this
due to L7510 stating that it is for 'minor' parts, and the Truestep
Exoskeletal foot is not something I would consider something minor such as a
strap, buckle, etc..
The entire foot is being replaced, so I don't actually think that using
L5979 is that far off base either, but I am concerned that if I use that
code that there will be an issue when I provide the patient with an entirely
new prosthesis in a month or two, most likely using the same code because
this is the preferred foot.
Any suggestions on how to go about this appropriately and cleanly ?




Replies are as follows:

 

I think you have already settled upon your foot selection.

A. Since that is done I suggest that you code it appropriately: The labor to
identify problem, and the immediate required repairs to his prosthesis
before he left your office. Other labor expended for your time could have
involved looking in a catalogue or speaking with a College Park customer
service agent. Justifiable charges could be 1 unit to 4 units of labor.

B. Since the patient already likes and has confidence with his Exo. I may
project you are going to give him another Exo.. You can then use the new
College Park foot you are providing this month. *You will probably need to
bill for parts describing the the exo. ankle extension to mount the College
Park foot when you transfer it onto his new definitive for the delivery.

C. If everything is clear to you then hopefully you have discussed all this
with the patient and it is clear to them. Now ask your patient to sign their
ABN responsibility to pay your bill. This makes them aware that they are
part of this process. They are the owner of the new leg you are building
for them. They are financially responsible. Explain that for their money
they get your companies warranty to provide all services for warranty
replacement if necessary, labor free during warranty to repair, or make any
adjustments during the warranty period of________,2012 or/and 2013 for some
parts with a 24 month warranty lets say for the foot, or manufacturer for
the knee unit.

D: The important question now regards the 500 pound gorilla in the exam
room. You ask the patient if they have a back up prosthesis. If they answer
No we often make this the patients problem our problem. It happens
every time the voice inside our head recites: There but for the grace of
G_d go I. Remind yourself the next time your in an ocean eddy that you do
not have the wings of angel, and do not have them in your O and P office.
So you bring up the fact that fact to the patient, and let him know the
problems in Medicare approving all the services. You can put a Exo.Childs
SAFE foot on for his back up,or some other single axis foot, and save the
Cadillac foot for his definitive. But it is important the patient know that
this process begins and ends with themselves. The human kindness, and where
the financial responsibility lies is your call.

------------------------------------------

 

Can you not transfer the new foot from the old to the new leg? I guess I am
assuming that you will be replacing the guys' exo with another exo. If he's
never worn an endo, he'll be pissed when he needs another leg after only
five years. That's the beauty of exo: Lasts longer, as there are fewer parts
to replace.

 

Anyway... If you are going to replace the leg with another exo, buy your
foot, and put it on the patient now. When you are ready to dynamically align
the new leg, take the foot (temporarily) off the old leg and put it on the
new leg. Before your patient leaves, remove the foot and put the leg in your
transfer jig. You may want to take a tracing of the top of the foot so you
can make a 1/8 thick polypro template of the top of the foot. You can use
this template both for shaping as well as a recording of your foot rotation.

 

When you fit the new leg, you will also be billing for the foot that he has
been using for a month or two. Basically, you are just allowing him to use
the foot for free for a month or so, until you get the new leg ready to go.

Personally, knowing that he's going into a new prosthesis, I'd just look
around and find him a decent used foot he can get by on, for the time being
and as a back up. And not even bother with being paid for it.

Or, bill for the foot now, whatever codes for the foot are, along with RP
modifier, but then transfer new foot onto his new prosthesis, and simply do
not bill for the foot on the new one. But, in this manner, he ends without a
backup prosthesis.

Or, you can offer him to cash buy a foot for his old prosthesis, sign ABN,
section D marked, and find him inexpensive decent foot he can use, without
major financial burden for him. A Dacor foot maybe.

I totally agree with you and concern on Medicare. It's tripping RACs in a
heartbeat.

 

Happy New Year to you too -

 

If providing the replacement foot on the old prosthesis AND a new full
prosthesis in a couple of months, we would do the following:

 

Bill the L5679 for the foot - Enter a reference to replacing
out-of-warranty, broken foot provided on DOS __/__/___ in the HAO field.

You may need to give his former prosthetic company a call for this.

 

I wouldn't use the L7510/L7520 because this is not a minor part. After much
hounding, we finally got an official ruling from PDAQ that L5999 should be
used when replacing foot shells, not L7510/L7520, because foot shells are
not a minor part. A foot is obviously more $$ than a foot shell.

 

When he comes back for his new prosthesis, I wouldn't proceed until a solid
LOMN from his physician was on hand documenting why he needs the new
prosthesis and that his physician wants him to have the old one as a backup
for such and such reasons.

 

To do this with no worries, you could skip billing for the foot
replacement, pull an old foot off your shelves for him to use with his
backup and then proceed with providing/billing for only the new prosthesis.

 

Hope that helps - Thanks,

You may want to consider billing L5979 for the foot now with the proper
replacement modifier and then bill the new device as a socket replacement in
the near future.

 

If they've had the current prx for 10 years without a back-up, it may not be
a concern to transfer the new foot over to the new device. But, it could be
a pain for you during the new fabrication and alignment process.

 

I would agree with your concerns about not billing the new foot as
L7510...or billing a L5979 now and providing a second L5979 with the new prx
soon. To me, those would both be flags for possible reimbursement issues,
etc.

 

Tough spot any way you look at it. Another option is to explain it to the
patient and obtain an ABN.

Just a thought.

Paul, put on a old foot to use, until the new prosthesis. Save your self a
lot of grief.

 

you are allowed to bill the repair/replacement if the prosthesis is unsafe


and then provide it again with the new prosthesis. Generally this refers to
minor repairs, but you could bill the code twice. I would document that
with photos. If you have trouble justifying, even in your own mind, you
could exchange the new foot at the time of fitting with the sach, or
whatever foot is described in the base code of the new onto the old
prosthesis calculating the time x7520 as the repair cost.

My thoughts on this situation is you can only bill Medicare for one foot. I
would suggest you keep focused on designing a new prosthesis and have him
pay for the replacement foot on his old prosthesis using an ABN and a misc
code.

You can get yourself in a world of trouble thinking that replacing a foot on
a exo is simple. It can be however you can break the bolt, twist the t-nut
in the prosthesis and/or have to duplicate or replace and the whole
prosthesis. I would not attempt to repair the prosthesis until you fit him
with a new prosthesis. The patient needs a leg to STAND ON.

 


                          ********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.

If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>

OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.

Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.