Alignable System Results...

Alignable System Results...

Richard Feldman

8/2/2017

Dear List Serve:

Below are the responses I received regarding the question I had billing an
Alignable system for a BK or AK socket change.
The Medicare LCD determination appears to be clear to not allow the
Alignable procedure code but as you can read from the responses below there
are quite a few individuals who differ to that opinion.
Thanks again to everyone who responded,
Richard Feldman, cpo

Hi Rick,
 This recently came up as a discussion with our local VA and was denied
according to what they are saying was a mandate in mid-2016 which no one
seems to be able to find. My company is fairly conservative with billing
and although we will not bill the VA for this code on socket replacements,
we will bill Medicare and private insurance and I have not had any kickback
to date. Hope this helps but certainly would like to hear other replies as
well.

The Medicare rule appears to be clear to not use the Alignable code with
replacement Socket Changes.

Hi Richard. Your reliable source is correct. Medicare published a few
years ago that alignable system codes can only be billed w prosthesis not
socket changes.

Rick: Always heard this to be true. When billing for a socket
replacement, alignable system is not a valid code.
We all know that many times the components from the existing device do not
meet the new socket's alignment needs (especially when provided by another
facility). We have been successful in getting reimbursed for individual
component(s) by explaining the need & using a miscellaneous code.
It's easier to bill for a preparatory device including S.S. alignable
system then billing a definitive with light wt alignable system vs
explaining every little thing needed in a socket replacement. Unavoidable
at times, understood.

I cannot say if it has been denied recently, but the only time I bill for
alignable system in a socket replacement is when I have to replace a pylon
and tube clamp or dual adapter. This has been most common after the first
socket replacement when the patients volume has changed significantly and
actually lost length of their residual limb. I always make sure to
document this well. I think it has been questioned in the past, but I can
easily justify.

Hi Rick,
I have billed for it when doing socket replacements without issues. I
reason that the Alignable system covers the new four hole
connector/plate/pyramid and usually a new pylon. New socket often means new
build heights so new components are needed. Just my thoughts.

Rick, Here is what I have found in the past:

<URL Redacted>
cd-9964-4784-a5d6-7cbd2d9236fd


<URL Redacted>
19-ed3b-45d6-a5ce-8a383c477885

<URL Redacted>
8c-5707-4b6b-bcdb-e2bfdb344562

Hi Rick, It is true they had a letter stating they would deny alignable
systems with Socket replacements. We ALWAYS proved new alignable components
with Socket changes and have taken the position that the alignable code is
justified and defendable

Rick, Yes, I always bill for alignable system for replacement sockets. You
have to replicate the alignment and put in your proper hardware, pyramid
etc...hope this helps.