1. Dx. Specific DME Protocols MPMA Summer Meeting Hal Ornstein, DPM, FACFAS Chairman, AAPPM 18 Years in Private Practice President of the Jeff Frederick Fan Club

2. REASONS TO FOLLOW THESE PROTOCOLS Improved outcomes Easy to follow Medico-legal security Improved patient compliance Improved patient satisfaction Patient convenience Ease of inventorying Consistent with standards of care

3. Documentation Summary, Chart  Prescription or order  Documentation of Therapeutic Necessity  Signed Certification of Patient Receipt  Chart Notes of Dispense  Invoice

4. Documentation Summary, Office Complaint Resolution Policy, Forms, Log Complaint Resolution Policy, Forms, Log Supplier Standards Supplier Standards Warrantee Info Warrantee Info Posted hours Posted hours

5. DME Codes L2999Non covered L2999Non covered L1902AFO gauntlet style L1902AFO gauntlet style L1906AFO multiligamentous L1906AFO multiligamentous L4386AFO non-pneumatic walking L4386AFO non-pneumatic walking L4396AFO plantar fascia night splint L4396AFO plantar fascia night splint L4360AFO pneumatic below knee L4360AFO pneumatic below knee L1971AFO with ankle joint L1971AFO with ankle joint L4350AFO ankle control orthosis L4350AFO ankle control orthosis L1932AFO dynamic L1932AFO dynamic L1951AFO spiral, plastic, other L1951AFO spiral, plastic, other

6. DME Codes L1940, L2210, L2330, L2820 L1940, L2210, L2330, L2820 Arizona AFO, dynamic assist Arizona AFO, dynamic assist L1970, L2210, L2820 L1970, L2210, L2820 Richie AFO, dynamic assist Richie AFO, dynamic assist L1940, L2330, L2820 L1940, L2330, L2820 Arizona AFO, standard Arizona AFO, standard L1970, L2820b L1970, L2820b Richie AFO Richie AFO L1940, L2330, L2820 L1940, L2330, L2820 Arizona AFO, tall Arizona AFO, tall L1960, L2340, L2820 L1960, L2340, L2820 Arizona AFO extended Arizona AFO extended A5501, A5506, A5503 A5501, A5506, A5503 Custom molded shoes with rocker bottoms and offset heels Custom molded shoes with rocker bottoms and offset heels L1940, L2330, L2820, A5501, A5506, A5503 L1940, L2330, L2820, A5501, A5506, A5503 Custom molded shoe with Arizona Standard AFO Custom molded shoe with Arizona Standard AFO

7. Plantar Fasciitis 728.71Plantar fascial fibromatosis 728.71Plantar fascial fibromatosis 718.47 Plantarflexion contracture of ankle 718.47 Plantarflexion contracture of ankle

8. Plantar fasciitis: Initial Visit Aircast Airheel Suggested Code:L2999 Patient Pays PowerStep Insert Suggested Code:L2999 Patient Pays

9. Plantar fasciitis: Subsequent Visit Night Splint, posterior or dorsal Suggested Code:L4396 DMEPOS Fee Ceiling:$180 Mild Ossur Formfit Ossur Airform Ossur Exoform

10. Plantar fasciitis: Subsequent Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Severe Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

11. Posterior Tibialis Tendonitis 726.72Tibialis tendonitis 726.72Tibialis tendonitis 905.8 Late effect of tendon injury, sprain, strain 905.8 Late effect of tendon injury, sprain, strain

12. Posterior Tibialis Tendonitis, Mild: Initial Visit Aircast Airlift PTTD Suggested Code:L1906 DMEPOS Fee Ceiling:$135 PowerStep Insert Suggested Code:L2999 Patient Pays

13. Posterior Tibialis Tendonitis, Moderate : Initial Visit Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505

14. Posterior Tibial Tendonitis: Severe, Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

15. Posterior Tibialis Strain, Moderate : Subsequent Visit Night Splint, posterior or dorsal Suggested Code:L4396 DMEPOS Fee Ceiling:$180 Ossur Airform Ossur Formfit Ossur Exoform

16. Posterior Tibialis, Rupture, Stage 3 727.68Rupture, tendon of foot and ankle, non- traumatic 727.68Rupture, tendon of foot and ankle, non- traumatic 728.4Laxity of ligament 728.4Laxity of ligament 734Flat foot, acquired 734Flat foot, acquired

17. Posterior Tibialis Strain, Rupture, Stage 3: Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

18. Posterior Tibialis Strain, Rupture, Stage 3: Subsequent Visit, if getting better Aircast Airlift PTTD Suggested Code:L1906 DMEPOS Fee Ceiling:$135 Less Severe Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505 More Severe

19. Posterior Tibialis Strain, Rupture, Stage 3: Subsequent Visit, if getting worse Arizona AFO Suggested Code:L1940, L2330, L2820 DMEPOS Fee Ceiling:$1099 Richie AFO Suggested Code:L1970, L2820 DMEPOS Fee Ceiling:$901

20. Ankle Sprain, Grade 1 845.02Sprain and strain of ankle and foot, calcaneofibular 845.02Sprain and strain of ankle and foot, calcaneofibular 845.00Sprain and strain of ankle and foot, unspecified site 845.00Sprain and strain of ankle and foot, unspecified site 729.5Pain in limb 729.5Pain in limb 719.07 Unspecified disorder of ankle and foot 719.07 Unspecified disorder of ankle and foot

21. Ankle Sprain, Grade 1 : Initial Visit Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135

22. Ankle Sprain, Grade 2, 3 729.5Ankle pain and support 729.5Ankle pain and support 719.07 Effusion of joint, ankle, foot 719.07 Effusion of joint, ankle, foot 845.02Sprain and strain of ankle and foot, calcaneofibular 845.02Sprain and strain of ankle and foot, calcaneofibular 845.01Sprain and strain of ankle and foot, deltoid ligament 845.01Sprain and strain of ankle and foot, deltoid ligament 824.2Ankle fracture, lateral malleolus only 824.2Ankle fracture, lateral malleolus only 824.6Ankle fracture, trimalleolar 824.6Ankle fracture, trimalleolar

23. Ankle Sprain, Grade 2, 3: Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

24. Ankle Sprain, Grade 2, 3: Follow up visit, 2 - 6 weeks Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135 Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505 Delayed HealingHealing Well

25. Pediatric Fracture 729.5Ankle pain and support 729.5Ankle pain and support 719.07 Unspecified disorder of ankle and foot 719.07 Unspecified disorder of ankle and foot 845.02Sprain and strain of ankle and foot, calcaneofibular 845.02Sprain and strain of ankle and foot, calcaneofibular 845.01Sprain and strain of ankle and foot, deltoid ligament 845.01Sprain and strain of ankle and foot, deltoid ligament 824.2Ankle fracture, lateral malleolus only 824.2Ankle fracture, lateral malleolus only 824.6Ankle fracture, trimalleolar 824.6Ankle fracture, trimalleolar

26. Pediatric Fracture: Initial Visit Pneumatic Walker, Pediatric Size Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Aircast SP Walker Aircast XP Walker

27. Pediatric Fracture: Follow up visit, 7 - 9 weeks Aircast Air-Stirrup, pediatric size Suggested Code:L4350 DMEPOS Fee Ceiling:$100

28. Ankle Instability 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.00Sprain and strain of ankle and foot, unspecified 845.00Sprain and strain of ankle and foot, unspecified

29. Ankle Instability: Initial Visit Mild Moderate Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135 Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505

30. Tarsal Tunnel Syndrome 355.5Tarsal tunnel syndrome 355.5Tarsal tunnel syndrome 719.47 Pain in joint, ankle, foot 719.47 Pain in joint, ankle, foot

31. Tarsal Tunnel Syndrome : Initial Visit Mild Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135 Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505 Moderate

32. Tarsal Tunnel Syndrome, severe : Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

33. Peroneal Tendonitis ???? ?????????

34. Peroneal Tendonitis : Initial Visit Mild, Moderate Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135

35. Peroneal Tendonitis, severe : Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

36. Peroneal Tendonitis : Subsequent Visit Severe Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135

37. Sinus Tarsi Syndrome 726.79Enthesopathy of ankle and tarsus, other 726.79Enthesopathy of ankle and tarsus, other 719.47 Pain in joint, ankle, foot 719.47 Pain in joint, ankle, foot

38. Sinus Tarsi Syndrome : Initial Visit Mild Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135 Donjoy Velocity ES Suggested Code:L1971 DMEPOS Fee Ceiling:$505 Moderate

39. Sinus Tarsi Syndrome : Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

40. Severe Sinus Tarsi Syndrome : Subsequent Visit Ossur Gameday Suggested Code:L1906 DMEPOS Fee Ceiling:$135

41. Drop Foot 736.79Acquired deformity of foot and ankle 736.79Acquired deformity of foot and ankle 438.20 Hemiplegia 438.20 Hemiplegia 719.97Joint derangement, ankle and foot 719.97Joint derangement, ankle and foot 356.1Peroneal muscle atrophy, Charcot Marie Tooth disease 356.1Peroneal muscle atrophy, Charcot Marie Tooth disease 340Multiple sclerosis 340Multiple sclerosis 138Poliomyelitis, late effects 138Poliomyelitis, late effects 728.85Spasm of muscle 728.85Spasm of muscle

42. Flaccid Drop Foot : Initial Visit Euro International Peromax Suggested Code:L1932 DMEPOS Fee Ceiling:$962 Ossur Dynamic Suggested Code:L1951 DMEPOS Fee Ceiling:$905

43. Arizona Dorsiflex Assist Suggested Code:L1940, L2210, L2330, L2820 DMEPOS Fee Ceiling:$1174 Richie Dynamic Assist Suggested Code:L1970, L2210, L2820 DMEPOS Fee Ceiling:$976 Spastic Drop Foot : Initial Visit

44. Rigid Equinovarus 736.71Equinovarus, acquired 754.51Equinovarus, congenital 728.85Spasm of muscle

45. Rigid Equinovarus : Initial Visit Arizona AFO, Tall, foot plate to sulcus Suggested Code:L1940, L2330, L2820 DMEPOS Fee Ceiling:$1099 Arizona AFO, Extended Suggested Code:L1960, L2330, L2820 DMEPOS Fee Ceiling:$1179

46. Achilles Tendonitis, Achilles Tendon Tear 845.09Achilles tendon strain, tear 845.09Achilles tendon strain, tear 726.71 Achilles tendonitis 726.71 Achilles tendonitis

47. Achilles Tendonitis, Achilles Tendon Tear : Initial Visit Pneumatic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Ossur Equalizer Low Top Ossur Equalizer Premium Aircast SP WalkerAircast FP Walker

48. Achilles Tendonitis, Achilles Tendon Tear : Second visit Night Splint, posterior or dorsal Suggested Code:L4396 DMEPOS Fee Ceiling:$180 Ossur Airform Ossur Formfit Ossur Exoform

49. Achilles Tendonitis, Achilles Tendon Tear : Follow up visit Bauerfeind Achilleotrain Suggested Code:L1902 DMEPOS Fee Ceiling:$90.11

50. Metatarsal Fracture 733.10Stress fracture, unspecified 733.10Stress fracture, unspecified 825.25 Fracture of the metatarsal bone 825.25 Fracture of the metatarsal bone

51. Metatarsal Fracture : Initial visit Ossur Equalizer Low Top Walker Suggested Code:L4386 DMEPOS Fee Ceiling:$171 Darco Med-Surg Walker Suggested Code:L2999 DMEPOS Fee Ceiling:Patient pays

52. Metatarsal Fracture : Follow up visit PowerStep readymade orthotic Suggested Code:L2999 DMEPOS Fee Ceiling:Patient pays

53. Charcot, Active 713.5Arthoropathy associated with neurological disorder 713.5Arthoropathy associated with neurological disorder 715.17 Osteoarthritis, localized foot and ankle 715.17 Osteoarthritis, localized foot and ankle

54. Charcot, Active, Goals of Treatment Prevent further deformity Prevent further deformity Obtain a plantargrade foot Obtain a plantargrade foot Avoid excess pressure on skin Avoid excess pressure on skin

55. Charcot, Active: Initial Visit Total Contact Cast, non- weight-bearing Aircast XP Diabetic Walker Suggested Code:L4360 DMEPOS Fee Ceiling:$312 Bledsoe Charcot Conformer Suggested Code:L4360 DMEPOS Fee Ceiling:$312

56. Charcot, Active, Follow-up Visit CROW if patient non-compliant and bearing weight Suggested Code:L1960, L2340, L2820 DMEPOS Fee Ceiling:$1228

57. Charcot, Static 715.17 Osteoarthritis, localized foot and ankle 715.17 Osteoarthritis, localized foot and ankle 735.9Unspecified deformity of ankle and foot, acquired 735.9Unspecified deformity of ankle and foot, acquired

58. Charcot, Static, Treatment Custom mold shoes, offset heels and rocker bottoms Suggested Code:A5501, A5506, A5503 DMEPOS Fee Ceiling:$519 AZ AFO with removable footbed and Custom mold shoes Suggested Code:L1940, L2330, L2820, A5501, A5506, A5503 DMEPOS Fee Ceiling:$1618

59. Disclaimer: Suggested codes are based on publically 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 the 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. The authors and the American Academy of Podiatric Practice Management accept no responsibility whatsoever in this regard.

60. Thank You!