Preparatory vs Definitive
Barnhart Prosthetics
Description
Collection
Title:
Preparatory vs Definitive
Creator:
Barnhart Prosthetics
Date:
2/10/2012
Text:
Hello,
Can anyone explain how a Preparatory prosthesis is different from a Definitive prosthesis, aside from the specific code restrictions that are non covered on a preparatory.
I find no place in medicare that claims that a prep is to be used on a patient for their first prosthesis, or anything like that in definitions. The 2 theories I have heard on this are: 1. to provide a preparatory, with a more basic foot initially, then replace the entire prosthesis later when the patient shrinks out of it and needs a more active foot; vs
2. providing a definitive prosthesis up front, with the foot that is more suitable for the patient long term, that would not be billable with a prepartory (L5980), then do socket changes when they shrink out of the socket. I do not see any guidance from Medicare that says what constitutes a preparatory vs a definitive and when either is required to be billed for.
I am not asking for opinions on which way you think is better, I am asking for any guidance that you have that relates to Medicare requirements on using a Preparatory vs a Definitive in coding, or explanation of how one is truly different from the other physically, not just in coding variation.
Thanks
Nathan Keepers, CPO
Can anyone explain how a Preparatory prosthesis is different from a Definitive prosthesis, aside from the specific code restrictions that are non covered on a preparatory.
I find no place in medicare that claims that a prep is to be used on a patient for their first prosthesis, or anything like that in definitions. The 2 theories I have heard on this are: 1. to provide a preparatory, with a more basic foot initially, then replace the entire prosthesis later when the patient shrinks out of it and needs a more active foot; vs
2. providing a definitive prosthesis up front, with the foot that is more suitable for the patient long term, that would not be billable with a prepartory (L5980), then do socket changes when they shrink out of the socket. I do not see any guidance from Medicare that says what constitutes a preparatory vs a definitive and when either is required to be billed for.
I am not asking for opinions on which way you think is better, I am asking for any guidance that you have that relates to Medicare requirements on using a Preparatory vs a Definitive in coding, or explanation of how one is truly different from the other physically, not just in coding variation.
Thanks
Nathan Keepers, CPO
Citation
Barnhart Prosthetics, “Preparatory vs Definitive,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/233388.
