Replies: Post surgical Prosthesis or Definitive? Part I

Replies: Post surgical Prosthesis or Definitive? Part I

Jeremy Sprouse

3/8/2013

Thanks to all who responded. One practitioner thought this discussion could
be considered price manipulation or collusion, However; I personally was
just trying to come up with some way to show functional level beyond a
reason of a doubt. The reason this has come up in my practice is due to a
new patient who underwent 2 years of attempted limb salvage before his
amputation. So for year one he was using crutches until he developed
shoulder issues. For the last year he has been in a wheelchair and he
finally convinced his doc to just amputate. So his last two years of
documented functionality are not his true potential. I was thinking a post
op prosthesis would help to build the documentation for the K3 level I hope
he returns to. I am finding docs are not really good at functional
levels.and having the patient walk in and out of his office (on a post op)
would certainly have to help the doc better document the K level. I also
like the idea of the post op prosthesis being a back up for the patient. I
think I will stick with a definitive and hopefully get the doc and therapist
to agree to his potential. Again thanks to all who responded, as you can
see from the replies below, this is another topic with many different
opinions.

Jeremy Sprouse CPO

 

Jeremy,
It has always been my practice to fit with a preparatory prosthesis and then
a definitive after three to six months. In that timetable frame u may have
to bill for a replacement socket to the temp with large volume decreases.
Doesn't happen often though.
It just makes good sense.
1- Yes, I bill no higher than a K 2 level for the prep.
2- Yes, it helps in determining future K Levels for definitive
3- Most importantly, the patient now has a back up prosthesis to
     use in case of any breakage to their definitive which may
     require several days to repairer due to part ordering etc...

 

Hope my rationale helps,

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Jeremy I think your reinventing the wheel. First may I say since your
question is being discussed into a public forum. I think they (US govt.)
would call it an attempt at collusion (price manipulation. It's dangerous to
do that, so please talk to some professionals you have met in your career,
or call AOPA, or ask your state O and P group for any problems you have with
government regarding the use of LCodes used for billing.

You activity level justification is O.K. but definitely incomplete. Over the
last year there is an agreed and what is sanctioned to be an clinical
activity amputee questionnaire. Go to the AAOP web site, or call
NorthWestern U. to but get it. That along with a PT eval. and documenting
what you have done, plus the additional material above should will put you
in better shape. O&P products (services) are billed to include your clinical
time; unlike therapists that can bill for all their time for the eval, the
product, and the education of the product.

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Definitive prosthesis=audit

Good foot=audit

Socket change=audit

Preparatory prosthesis+crappy foot=bad gait habits and try justifying K
level change later.

I have been there, brother. Just like you. Now, I am not doing prosthetics
to help patients, I am snaking through the loopholes and what's available
not to trigger an audit.

 

Be well.

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