Hello List Serve Community,
I have a question that seems like it should have been concretely answered
years ago and yet I cannot find clear guidance anywhere (With the exception
of a discussion from 2013 in the O and P Edge).
I have a Medicare patient that has recently undergone a TMA. I would like
to pair a toe filler with a OTS carbon fiber anterior panel AFO (L1932).
Research that was published in 2007 during our state-of-the-science
conference shows the clear functional benefits of using a tibial tubercle
height partial foot prosthesis (not to mention wound prevention). This
should be our standard of care at this point as I see it.
My question is this, How do you code and bill this through Medicare since
L5000 and L1932 are from separate LCDs? The patient has ankle equinus,
like most TMAs, so I have justification to bill an AFO. Would you (*A*)
bill them all on one delivery ticket using TMA as the primary diagnosis and
ankle equinus as the secondary diagnosis? Or (*B*) separate the claims
onto separate delivery tickets using TMA for the toe filler and ankle
equinus for the AFO? Or (*C*) do something else that I haven’t thought of.
I really appreciate any links you have to Medicare guidelines on this if
you have found any.
Happy New Year!
Ashley Seefeld, CPO
Berke Prosthetics and Orthotics
2001 Winward Way, Suite 100
San Mateo, CA 94404
P: (650)-570-5861
F: (650)-365-5896
