Fwd: Question about L1843 Medicare LCD Jurisdiction C

Fwd: Question about L1843 Medicare LCD Jurisdiction C

Rachel Sidle

2/4/2014

Thank you to all that have replied. Apparently, we missed a part in the
LCD, and we are not the only ones. It reads that L1843 is covered if the
pt is ambulatory, has documented knee instability, and has any of the
listed diagnoses:


DiagnosisICD-9
Rheumatoid arthritis714.0 - 714.4
Osteoarthritis715.16, 715.26, 715.36, 715.96
Meniscal cartilage derangement717.0 - 717.5
Chondromalacia of patella717.7
Knee ligamentous disruption717.81 - 717.9
Rupture of tendon, nontraumatic - quadriceps tendon727.65
Rupture of tendon, nontraumatic, site-patellar tendon727.66
Pathologic fracture of femur733.15
Pathologic fracture of tibia or fibula733.16
Aseptic necrosis of tibia or fibula733.49
Malunion of fracture - nonunion of fracture733.81-733.82
Stress fracture of tibia or fibula733.93
Congenital deformity of knee755.64
Fracture of femur - lower end821.20 - 821.39
Fracture of patella822.0, 822.1
Fracture of tibia and/or fibula - upper end823.00 - 823.42
Dislocation of knee836.0 - 836.69
Sprains and strains of knee844.0 - 844.2, 844.8
Late effect of fracture of lower extremities905.4
Failed total knee arthroplasty996.40 - 996.49, 996.66, 996.77, V43.65


DiagnosisICD-9
Multiple sclerosis340
Hemiplegia, unspecified; dominant side; nondominant side342.90, 342.91,
342.92
Infantile cerebral palsy, unspecified343.9
Paraplegia of both lower limbs344.1
Mononeuritis of lower limb, unspecified355.0, 355.2


Here is the link to the LCD for jurisdiction C.
<URL Redacted>

Thanks again.

Rachel Sidle, CPO, LPO
Memphis, TN


---------- Forwarded message ----------
From: Rachel Sidle < <Email Address Redacted> >
Date: Mon, Feb 3, 2014 at 4:26 PM
Subject: Question about L1843 Medicare LCD Jurisdiction C
To: <Email Address Redacted> < <Email Address Redacted> >


Dear List,

I had a pt in the office today with severe genu varum that has been wearing
an unloading single upright KO for 11 years, and it is needing to be
replaced. The problem is that my interpretation of the Medicare LCD #22664
for knee orthoses states that L1843 is either covered if the pt has had a
recent injury or surgery and OA, or has hemiplegia/MS/CP. He has OA and a
severe deformity, but is using the brace to prevent surgery. He has
already had a TKA on his other side, but is 90 years old and does not want
another surgery and he is managed well with the KO.

Am I just misinterpreting the LCD? L1843 singe upright unloading KO was
designed for varus/valgus deformity and OA, but Medicare seems to only want
to pay if they had a recent injury or surgery.

We sent him to his PCP for documentation of his needs, but would like to
let him know when he returns if Medicare will cover it or not.

If you have a different understanding of the coverage, please let me know,
and please back it up with documentation if you have it. Or if you have
had L1843 covered without injury or surgery, please let me know.

Thanks.

Rachel Sidle, CPO, LPO
Memphis, TN