Medicare resting AFO: Responses page 2

Medicare resting AFO: Responses page 2

Randy McFarland

1/10/2016

I would do this. Have the physician examine the patient and state the
following if it applies:

I have examined the patientPt is ambulatory but ambulation is limited due to
foot position and open sore on heelPt has deformity - plantar flexed foot
and ulcer on superior aspect of heel that tears each time the foot is
positioned into dorsiflexion for ambulationPt needs brace to stabilize foot
and ankle because of a plantar flexion contracture and/or drop foot.Pt will
benefit because she will be able to ambulate and stretch contracture without
further damage to tissueAnd requires custom because:Off the shelf will not
work due to foot position. No ots brace is designed to fit a foot that is
not in a neutral positionCondition will most likely last longer than 6
monthsPt has documented orthopedic (?neurological?) status that requires
custom fabricating over a model to prevent tissue injuryIf the physician
will document these from the LCD, I think you would pass any audit. And I
would ask the doc to use these exact words (or yours)

 

Coverage of this for non ambulatory patients if 1-4 is true1 Plantar flexion
contracture of the ankle (ICD 9 diagnosis code 718.47) with dorsiflexion on
passive range of motion testing of at least 10 degrees (i.e., a nonfixed
contracture), and2 Reasonable expectation of the ability to correct the
contracture, and 3 Contracture is interfering or expected to interfere
significantly with the patient's functional abilities; and 4 Used as a
component of a therapy program which includes active stretching of the
involved muscles and/or tendons.Or this The patient has plantar fasciitis
(ICD 9 diagnosis code 728.1) I have no problems getting coverage, you need
to be prepared to defend.

 

It will not be covered by medicare. Facility will have to pay. SNFs have
asked me to bill the family and I tell them no because there is a medical
neccesity during her stay and the facility has to provide for her needs. A
lot of my SNFs have resulted to purchasing items through Alimed.
Disheartening as it is, this is the world we live in.

 

Medicare would require extensive ROM/therapy documentation for payment.
Their are 5 criteria in the rules that must be met so tread carefully.