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Diagnosis Specific DME Treatment Protocols Super Saver Cleveland, Ohio October 28, 2010 Hal Ornstein, DPM, FASPS AAPPM Chairman Private Practice Howell, New Jersey Reasons To Follow These Protocols... Improved outcomes Easy to follow Medico-legal security Improved patient satisfaction Patient convenience Ease of inventorying Consistent with standards of care ***Fee Ceiling: as published for 2010 Commonly used Prefabricated AFO Categories/DME HCPCS Codes L2999 L1902 L1906 L4386 L4396 L4360 L1971 L4350 L1932 L1951 Non covered AFO, Gauntlet style AFO, Multiligamentous AFO, Non-pneumatic walking AFO, Plantarfascia night splint AFO, Pneumatic below knee AFO, With ankle joint AFO, Ankle control orthotics AFO, Dynamic AFO, Spiral, plastic, other Ankle Sprain ~ Grade 1 Possible Diagnosis Codes: 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.00 Sprain and strain of ankle and foot, unspecified site 729.5 Pain in limb 719.07 Unspecified disorder of ankle and foot Ankle Sprain ~ Grade 1 Initial Visit Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Ankle Sprain ~ Grade 2 & 3 Possible Diagnosis Codes: 729.5 719.07 845.02 845.01 824.2 824.6 Ankle pain and support Effusion of joint, ankle, foot Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, deltoid ligament Ankle fracture, lateral malleolus only Ankle fracture, trimalleolar Ankle Sprain ~ Grades 2 & 3 Initial Visit Ossur Equalizer Low Top Air Walker Ossur Equalizer Premium Air Walker Aircast SP Walker Ossur Rebound Air Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Ankle Sprain ~ Grade 2 & 3 Follow up visit, 2 - 6 weeks Healing Well Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Delayed Healing Donjoy Velocity ES Ossur Rebound Hinged Ankle Brace Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Ankle Instability Possible Diagnosis Codes: 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.00 Sprain and strain of ankle and foot, unspecified Ankle Instability: Initial Visit Mild Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Moderate Donjoy Velocity ES Ossur Rebound Hinged Ankle Brace Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Plantar Fasciitis Possible Diagnosis Codes: 728.71 Plantar fascia fibromatosis Plantar fasciitis: Initial Visit Aircast Airheel Suggested Code: L2999 Patient Pays PowerStep Insert Suggested Code: L2999 Patient Pays Plantar fasciitis: Subsequent Visit Ossur Formfit Posterior Night Splint Darco Dorsal Night Splint Ossur Airform Dorsal Night Splint Night Splint ~ Posterior or Dorsal Suggested Code: L4396 DMEPOS Fee Ceiling: $180 Plantar fasciitis: Subsequent Visit Severe Ossur Equalizer Low Top Air Walker Aircast SP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Posterior Tibialis Tendonitis Possible Diagnosis Codes: 726.72 Tibialis tendonitis 905.8 Late effect of tendon injury, sprain, strain Posterior Tibialis Tendonitis Mild Initial Visit PowerStep Insert Aircast Airlift PTTD Suggested Code: L2999 Patient Pays Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Posterior Tibialis Tendonitis Moderate: Initial Visit Donjoy Velocity ES Ossur Rebound Hinged Ankle Brace Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Posterior Tibial Tendonitis Severe, Initial Visit Ossur Equalizer Premium Air Walker Ossur Rebound Air Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Posterior Tibialis Tendon Rupture Stage 3 Possible Diagnosis Codes: 727.68 Rupture, tendon of foot and ankle, non-traumatic 728.4 Laxity of ligament 734 Flat foot, acquired Posterior Tibialis Tendon Rupture, Stage 3: Initial Visit Ossur Equalizer Premium Air Walker Ossur Rebound Air Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Posterior Tibialis Strain Rupture, Stage 3: Subsequent Visit, if getting better Less Severe Aircast Airlift PTTD Suggested Code: L1906 DMEPOS Fee Ceiling: $135 More Severe Donjoy Velocity ES Ossur Rebound Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Posterior Tibialis Tendon Rupture ~ Stage 3: Subsequent Visit, if getting worse Arizona Standard AFO Suggested Codes: L1940, L2330, L2820 DMEPOS Fee Ceiling: $1099 Richie AFO Suggested Codes: L1970, L2820 DMEPOS Fee Ceiling: $901 Post Op Bunionectomy, Metatarsal Osteotomy 825.25 719.47 Possible Diagnosis Codes: Fracture of the metatarsal bone Pain joint, foot Metatarsal Fracture Initial visit Ossur Equalizer Premium Low Top Walker Suggested Codes: L4386 DMEPOS Fee Ceiling: $171 Darco Med-Surg Walker Suggested Codes: L2999 DMEPOS Fee Ceiling: Patient pays Pediatric Fracture Possible Diagnosis Codes: 729.5 Ankle pain and support 719.07 Unspecified disorder of ankle and foot 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.01 Sprain and strain of ankle and foot, deltoid ligament 824.2 Ankle fracture, lateral malleolus only 824.6 Ankle fracture, trimalleolar Pediatric Fracture Initial Visit Ossur Rebound Air Walker Aircast XP Walker Pneumatic Walker, Pediatric Size Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Pediatric Fracture Follow up visit, 7 - 9 weeks Aircast Air-Stirrup, pediatric size Suggested Code: L4350 DMEPOS Fee Ceiling: $100 Tarsal Tunnel Syndrome Possible Diagnosis Codes: 355.5 Tarsal tunnel syndrome 719.47 Pain in joint, ankle, foot Tarsal Tunnel Syndrome: Initial Visit Mild Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Moderate Donjoy Velocity ES Ossur Rebound Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Severe Tarsal Tunnel Syndrome Initial Visit Ossur Equalizer Low Top Air Walker Aircast SP Walker Pneumatic Walkers Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Severe Tarsal Tunnel Syndrome: Subsequent Visit Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Peroneal Tendonitis Possible Diagnosis Codes: 726.79 Enthesopathy of ankle and tarsus Peroneal Tendonitis Initial Visit Mild to Moderate Ossur Game Day Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Peroneal Tendonitis ~ Severe Initial Visit Ossur Equalizer Low Top Air Walker Ossur Equalizer Premium Air Walker Aircast SP Walker Ossur Rebound Air Walker Pneumatic Walkers Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Peroneal Tendonitis Subsequent Visit Severe Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Sinus Tarsi Syndrome Possible Diagnosis Codes: 726.79 Enthesopathy of ankle and tarsus 719.47 Pain in joint, ankle, foot Sinus Tarsi Syndrome Initial Visit Mild Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Moderate Donjoy Velocity ES Ossur Rebound Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Sinus Tarsi Syndrome Initial Visit Ossur Equalizer Low Top Air Walker Aircast SP Walker Pneumatic Walkers Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Sinus Tarsi Syndrome ~ Severe Subsequent Visit Ossur GameDay Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Achilles Tendonitis Achilles Tendon Rupture Possible Diagnosis Codes: 845.09 Achilles tendon strain, rupture 726.71 Achilles tendonitis Achilles Tendonitis ~ Achilles Tendon Tear Initial Visit Ossur Equalizer Premium Air Walker Ossur Rebound Air Walker Pneumatic Walkers Suggested Code: L4360 DMEPOS Fee Ceiling: $312 Achilles Tendonitis ~ Achilles Tendon Tear Follow up visit Bauerfeind Achilleotrain Suggested Code: L2999 DMEPOS Fee Ceiling: Patient pays Metatarsal Fracture Possible Diagnosis Codes: 733.94 Stress fracture, unspecified 825.25 Fracture of the metatarsal bone Metatarsal Fracture: Initial visit Ossur Equalizer Premium Non-Pnematic Low Top Walker Suggested Code: L4386 DMEPOS Fee Ceiling: $171 Darco Med-Surg Walker Suggested Code: L2999 DMEPOS Fee Ceiling: Patient pays Metatarsal Fracture Follow up visit PowerStep ProTech Prefabricated Orthotic Suggested Code: L2999 DMEPOS Fee Ceiling: Patient pays Flaccid Drop Foot Possible Diagnosis Codes: 736.79 Acquired deformity of foot and ankle 438.20 Hemiplegia 719.97 Joint derangement, ankle and foot 356.1 Peroneal muscle atrophy, Charcot Marie Tooth disease 340 Multiple sclerosis 138 Poliomyelitis, late effects Flaccid Drop Foot : Initial Visit Euro International Peromax Suggested Code: L1951 DMEPOS Fee Ceiling: $905 Ossur Dynamic Suggested Code: L1932 DMEPOS Fee Ceiling: $962 Custom Order Form... One of the ways to get started with SafeStep... 1. Speak with SafeStep Account Manager 2. Ask about the Custom Order Form and the "My Favorites" page details 3. Ask for NS300 Discount code on your first order with SafeStep of AFO purchase Mention NS300 Discount Code and take advantage of this special offer today! Disclaimer: Suggested codes are based on publicly available information and are offered as a convenience to physicians. The authors make no claims, promises or guarantees as to the availability of reimbursement for any of the suggested products. It is within the sole discretion of physicians to determine the appropriate billing code for a product as well as whether the use of a product complies with medical necessity and other documentation requirements of the payor. Actual reimbursement may vary. Prices reflect 2010 HCPCS National Ceiling Fees. ***Not responsible for typographical errors. Thank you!