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

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

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

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

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

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

Plantar Fasciitis Plantar fascial fibromatosis Plantar fascial fibromatosis Plantarflexion contracture of ankle Plantarflexion contracture of ankle

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

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

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

Posterior Tibialis Tendonitis Tibialis tendonitis Tibialis tendonitis Late effect of tendon injury, sprain, strain Late effect of tendon injury, sprain, strain

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

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

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

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

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

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

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

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

Ankle Sprain, Grade Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, unspecified site Sprain and strain of ankle and foot, unspecified site 729.5Pain in limb 729.5Pain in limb Unspecified disorder of ankle and foot 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, Ankle pain and support 729.5Ankle pain and support Effusion of joint, ankle, foot Effusion of joint, ankle, foot Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, deltoid ligament Sprain 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

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

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

Pediatric Fracture 729.5Ankle pain and support 729.5Ankle pain and support Unspecified disorder of ankle and foot Unspecified disorder of ankle and foot Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, deltoid ligament Sprain 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

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

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

Ankle Instability Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, calcaneofibular Sprain and strain of ankle and foot, unspecified Sprain and strain of ankle and foot, unspecified

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

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

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

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

Peroneal Tendonitis ???? ?????????

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

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

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

Sinus Tarsi Syndrome Enthesopathy of ankle and tarsus, other Enthesopathy of ankle and tarsus, other Pain in joint, ankle, foot Pain in joint, ankle, foot

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

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

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

Drop Foot Acquired deformity of foot and ankle Acquired deformity of foot and ankle Hemiplegia Hemiplegia Joint derangement, ankle and foot Joint 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 Spasm of muscle Spasm of muscle

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

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

Rigid Equinovarus Equinovarus, acquired Equinovarus, congenital Spasm of muscle

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

Achilles Tendonitis, Achilles Tendon Tear Achilles tendon strain, tear Achilles tendon strain, tear Achilles tendonitis Achilles tendonitis

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

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

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

Metatarsal Fracture Stress fracture, unspecified Stress fracture, unspecified Fracture of the metatarsal bone Fracture of the metatarsal bone

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

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

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

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

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

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

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

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

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.

Thank You!