Hello colleagues, I am continually amazed at our profession and how we bring
trouble to our own door step. I am not going to mention any names only give
a recent discussion with a supplier. I was referred a Pt that had severe LE
weakness due to multiple issues needing bilateral AFOs (lightweight) to
ambulate. After trying a couple of prefabricated devices I was unable to
control her Rt LE recurvautum with an AFO alone and discussed with the Pt
the need to change to a KAFO. She understood but was very concerned with
weight as due to her syndrome she fatigues quickly. After trying to come up
with the best plan of care for her I came across a newer device in a
magazine that I had never used but knew that the lower leg section weighed
less than 1 lb. I ordered all necessary components and applied them to the
Pt. She was very pleased, as was I, on the drastic improvement it made in
her life, immediately ( I like the product). The Pt complied with all my
request to return to the Dr. for documentation. As I was getting ready to
put together the detailed Rx I thought how do I code this thing. I first
went to the PDAC website and what do you know it was useless. Then I went to
the manufacturer website and still no info. I finally called the company and
asked if they had any suggestions, which they stated “we have a list of what
practitioners have had success using “. Once I received the fax I laughed at
the combination of custom and prefab codes put together in the first section
then in the other section below it states other have had success with . and
gave a list of all custom components, and let me state there is not one
thing that is custom about this device other than contouring the uprights to
the Pt’s thigh and knee; which I do to any OTS KO I fit.
I know Medicare reps watch this site and my question to you is: why aren’t
you complying with your own suggestions and making these manufacturers
provide you with the device and assigning L codes prior to them being
allowed on the market; and secondly your priority list on who is audited is
flawed. You have the larger companies as the least likely to be audited but
these are the companies do the majority of the abuse NOT the small
established mom and pop companies; and to those who are saying I am blasting
Hanger, not so. There are some very good Hanger offices out there. Those of
you practitioners that are crying about unfair treatment need to look in the
mirror and realize some of you are responsible for the downfall of our
profession! I know there are several great practitioners and companies out
there that are fighting the good fight and not getting the reimbursement
they deserve and it is due to fraud and abuse that I see so frequently.
There is no quick fix but I try to do what is right for the Pt within the
letter of the law no matter how senseless it seems and it will not improve
until some of you are put out of business because of your abusive ways. So I
say bring on the audits and prepayment reviews. I hope it shuts some of you
down. I apologize for the grammatical errors, I make legs and braces (sorry
NUPOC “orthotics”) for a living and I hope I still have an industry in the
future.
Have a Merry Christmas
Chris Wells CPO,LPO
Frustrated with us not them
