1. WHEN PRESCRIBING AN ARTIFICIAL LIMB DOCUMENTATION GUIDE FOR PHYSICIANS

2. IT MIGHT HELP YOU TO KNOW WHY THESE CHANGES HAVE BEEN MADE.  In the past prosthetics have been made for amputees who had no motivation to use them and they go unused.  Some feet and/or knees have been provided to patients who don’t meet the activity requirements for those items.  Some outright fraud has occurred when a prosthesis is billed that was never provided, quite often to patients who are not even amputees.

3. Medicare does not expect the physician to be a prosthetic expert but, because it is in the prosthetist’s financial interest to provide these devices, Medicare needs independent verification that they are paying for items that are both needed and appropriate. These items cost thousands of dollars and it should only take a few minutes to provide the information Medicare requires.

4. You can find this letter at: www.cgsmedicare.com/jc/pubs/news/2011/cope15901.pdf Or click on this link: Medicare Dear Physician Letter August 2011 August 11, 2011 Medicare issued a Dear Physician Letter, Documentation of Artificial Limbs Documentation of Artificial Limbs, that outlined their expectation of the prescribing physician’s documentation.

5. ASK AND RECORD THE ANSWERS TO THE FOLLOWING QUESTIONS:  When did you have your amputation?*  What was the cause of your amputation?*  What level and side is the amputation?* *If they are an existing patient, these first 3 questions may already be answered in their medical history. Make sure they are included in your notes from the visit when the prosthesis is prescribed.

6. ASK AND RECORD THE ANSWERS TO THE FOLLOWING QUESTIONS:  What activities require you to use your prosthesis?  Assess if they are motivated to use a prosthesis?  What is the age of the prosthesis?  Are there any fit or functional problems with the prosthesis?

7. DO AN EXAMINATION AND RECORD:  Weight (note changes)  Height  Condition of residuum (healed, skin irritations, blisters, discoloration, volume/shape changes, etc.)  Any comorbidities that would hinder use of a prosthesis  Record gait/balance/coordination* *You can send them to a physical therapist for this assessment if you need.

8. Level 1-Are they home bound? – (household ambulator only) Level 2- Can they go up & down a step? – (limited community ambulator) Level 3 - Can they go fast & slow? - (typical adult ambulator) Level 4 - Are they very active with high impact activities? - (active adult/athlete/child) *Stating their Activity Level is not sufficient, you must note what they can do that makes them the determined Activity Level. *The higher the Activity Level, the better the foot and/or knee they are eligible for. *You can send the patient to a physical therapist for this assessment if you are uncomfortable with making these determinations. DO A FUNCTIONAL LEVEL ASSESSMENT* OF THE PATIENT’S CURRENT FUNCTIONAL LEVEL AND THEIR POTENTIAL (ANTICIPATED) ABILITIES ONCE FIT WITH A PROSTHESIS

9. A SHORT PARAGRAPH SIMILAR TO THIS EXAMPLE WOULD SATISFY MEDICARE’S REQUIREMENTS: Patient is a 68 year old male with a history of diabetes and high blood pressure. He is 5” 10” tall and 168 lbs. He is a unilateral below knee amputee on his left side. His amputation was in 1985 due to a car accident. His current prosthesis is over 6 years old and the foot is broken leaving the patient at risk of a fall. He has lost 25 lbs. since he was fit with his prosthesis. He has a blister on his residuum due to the poor fit of the prosthesis. He uses his prosthesis daily for activities such as shopping, golfing, walking for exercise, and playing with his grandchildren. Without the prosthesis, he would not be able to do these activities and would be limited to using a wheelchair for ambulation. He is anxious to get a better fitting prosthesis. He can go up and down steps and walks with variable cadence making him a Functional Level 3.

10. WE KNOW YOU’RE BUSY! So to assist you, we have prepared a helpful brochure which list 7 bullet points needed to meet Medicare’s requirements. To create a paragraph similar to that in the previous slide, just follow the 7 bullet points and hold a brief conversation with your patient. You can find this brochure on our website at AbleAgain.com. Go to the Concierge Page and click on the Physician’s Documentation Guide button or click on this link: Physician's Documentation Guide If we can assist you in any way, we will be glad to help If we can assist you in any way, we will be glad to help. Able Prosthetic CareAbleAgain.com 2141 Eastview Parkway(770) 922-5540 phone Conyers, GA 30013(770) 922-8535 fax