There is a common misperception in the profession that clinical documentation from an orthotist or prosthetist has no bearing in a formal claim review. This assumption is inaccurate, especially since clinical notes play an important (but different) role alongside the physician (MD, DO, NP, PA, CNS, etc.) documentation, providing additional context for a claim payment determination.
The Social Security Act Section 1861(s)(2)(K)(iii) provides a clear definition of a physician and the services they may provide. Unfortunately, orthotists and prosthetists are not included in this classification. This prohibits an orthotist or prosthetist from ordering a device or justifying medical necessity. Nevertheless, it remains best practice for orthotists and prosthetists to use their clinical evaluations to corroborate the medical necessity justification that has been documented by the treating physician. Just remember, orthotist and/or prosthetist notes cannot stand alone.
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