Fwd: AFO/KAFO policy
Jason Auyer
Description
Collection
Title:
Fwd: AFO/KAFO policy
Creator:
Jason Auyer
Date:
12/19/2012
Text:
Thank you for the responses. Only one person had a specific form that they
used for this. Here is the original post followed by the responses.
Dear Listserve,
I wanted to get some feedback from the list. I recently was on AOPA's
conference call and they discussed that not only do we need to be getting
K-level information for Medicare patients from physician's notes, but that
physicians also need to have in their notes justification for why we would
fit a custom AFO/KAFO instead of an OTS. Obviously we have to have this
info in our patient notes but I was not aware that Medicare was starting to
make physicians have this in their notes. Of course all the burden is on
us in the O&P community to make this happen because there is no incentive
for docs to do this.
A few questions:
1. Does anyone know the exact requirements that Medicare wants in these
situations?
2. Are your offices actively doing this for your Medicare patients?
3. Is the practitioner or the office staff handling this?
4. Are there specific forms people are using, or are you cutting and
pasting your notes, faxing to the doc and having them sign?
I will post responses
--
Jason Auyer, LCP, LCO
Licensed Certified Prosthetist, Licensed Certified Orthotist
Atlanta Prosthetics and Orthotics
1100 Sherwood Park Drive
Suite 220
Gainesville, GA 30501
ph: (770) 287-2395
fax: (770) 287-2398
www.atlantapo.com
RESPONSES:
Jason, My doctors are refusing to do these notes. I have told by more
than one doctor that he did not understand what all this meant, hence he
would not sign anything or write anything concerning the need and workings
of an appliance. I also was told today by an orthopedic surgeon that he
would not do it for the $60.00 Medicare office visit fee plus he was then
afraid he would be subject to these gestapo audits.
Find a good ox evaluation form, digital preferably.
Edit it so that at the end of it, there's line for physician, saying:
I have read and consent with proposed treatment plan for this patient.
Have Dr Nice sign and file it into HIS Pt chart. If they do electronic,
then here you go - you already have it in digital format.
This does not excuse you from finding from Dr Nice medical reasons for an
orthosis, say - for OA brace, custom, they have to have OA grade 3-4 at
least. But that should be routine Dr's notes. Good practice is to request
clinical notes along with Rx, to know where you standing and your
boundaries.
Yes, such evaluation here is done by practitioner, then OA handles faxing
etc.
Yes that is true about KAFO's and AFO's. Here is a document I created to
give to physicians to help them document correctly so that we can get paid.
There is actually more that they should do during their evaluation but we
all know they aren't going to do it so that's why I created this one page
document with the bare essentials. This information was pulled out of the
Medicare LCD for AFO's and KAFO's.
Don't start the orthosis until you have a complaint order and physicians
note. From there it's a leap of faith.
Good luck.
K levels were only created for Medicare purposes (like the Social
Security card was created for a single purpose and not as general ID), to
state the potential for a unilateral LE amputee to ambulate with a
prosthesis. It is not used for bilateral amputees (though I've had plenty
of commercial insurances require it), nor for orthotics. Custom AFOs can
be justified by simply stating the need for controlling motion in multiple
planes and/or stating specific unique anatomy of the patient, or that an
OTS was tried and failed along with the reasons why. The only prefab KAFO
code is L2035 pediatric, so beyond rationalizing why the patient needs a
KAFO, there should be no reason to justify custom.
Typically, I have my clerk obtain notes from the PT and physician. If
further documentation is required, then after I complete my notes, I
forward them on to the physician with a statement of any further
information that is required of him/her before we can proceed.
used for this. Here is the original post followed by the responses.
Dear Listserve,
I wanted to get some feedback from the list. I recently was on AOPA's
conference call and they discussed that not only do we need to be getting
K-level information for Medicare patients from physician's notes, but that
physicians also need to have in their notes justification for why we would
fit a custom AFO/KAFO instead of an OTS. Obviously we have to have this
info in our patient notes but I was not aware that Medicare was starting to
make physicians have this in their notes. Of course all the burden is on
us in the O&P community to make this happen because there is no incentive
for docs to do this.
A few questions:
1. Does anyone know the exact requirements that Medicare wants in these
situations?
2. Are your offices actively doing this for your Medicare patients?
3. Is the practitioner or the office staff handling this?
4. Are there specific forms people are using, or are you cutting and
pasting your notes, faxing to the doc and having them sign?
I will post responses
--
Jason Auyer, LCP, LCO
Licensed Certified Prosthetist, Licensed Certified Orthotist
Atlanta Prosthetics and Orthotics
1100 Sherwood Park Drive
Suite 220
Gainesville, GA 30501
ph: (770) 287-2395
fax: (770) 287-2398
www.atlantapo.com
RESPONSES:
Jason, My doctors are refusing to do these notes. I have told by more
than one doctor that he did not understand what all this meant, hence he
would not sign anything or write anything concerning the need and workings
of an appliance. I also was told today by an orthopedic surgeon that he
would not do it for the $60.00 Medicare office visit fee plus he was then
afraid he would be subject to these gestapo audits.
Find a good ox evaluation form, digital preferably.
Edit it so that at the end of it, there's line for physician, saying:
I have read and consent with proposed treatment plan for this patient.
Have Dr Nice sign and file it into HIS Pt chart. If they do electronic,
then here you go - you already have it in digital format.
This does not excuse you from finding from Dr Nice medical reasons for an
orthosis, say - for OA brace, custom, they have to have OA grade 3-4 at
least. But that should be routine Dr's notes. Good practice is to request
clinical notes along with Rx, to know where you standing and your
boundaries.
Yes, such evaluation here is done by practitioner, then OA handles faxing
etc.
Yes that is true about KAFO's and AFO's. Here is a document I created to
give to physicians to help them document correctly so that we can get paid.
There is actually more that they should do during their evaluation but we
all know they aren't going to do it so that's why I created this one page
document with the bare essentials. This information was pulled out of the
Medicare LCD for AFO's and KAFO's.
Don't start the orthosis until you have a complaint order and physicians
note. From there it's a leap of faith.
Good luck.
K levels were only created for Medicare purposes (like the Social
Security card was created for a single purpose and not as general ID), to
state the potential for a unilateral LE amputee to ambulate with a
prosthesis. It is not used for bilateral amputees (though I've had plenty
of commercial insurances require it), nor for orthotics. Custom AFOs can
be justified by simply stating the need for controlling motion in multiple
planes and/or stating specific unique anatomy of the patient, or that an
OTS was tried and failed along with the reasons why. The only prefab KAFO
code is L2035 pediatric, so beyond rationalizing why the patient needs a
KAFO, there should be no reason to justify custom.
Typically, I have my clerk obtain notes from the PT and physician. If
further documentation is required, then after I complete my notes, I
forward them on to the physician with a statement of any further
information that is required of him/her before we can proceed.
Citation
Jason Auyer, “Fwd: AFO/KAFO policy,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/234368.
