Wednesday, May 25, 2022

Re: Denials of Clamshell Boot Follow-up

Cesar Fernandez

356.1 is still not the correct diagnosis. If you look at the AFO/KAFO
policy, it mentions:

Group 2 Paragraph: For HCPCS code L4631:

Group 2 Codes:

713.5 ARTHROPATHY ASSOCIATED WITH NEUROLOGICAL DISORDERS

Cesar Fernandez
Billing Coordinator
Baker Orthotics & Prosthetics
Phone: 817) 332-7313 x 207
Fax: 817) 335-3604

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—–Original Message—–
From: Orthotics and Prosthetics List [mailto:[email protected]] On
Behalf Of Maggie Perez
Sent: Friday, July 18, 2014 7:31 AM
To: [email protected]
Subject: [OANDP-L] Denials of Clamshell Boot Follow-up

Thanks for all of the responses I received. Yes, I was talking about a “Crow
Boot”, L4631. In looking at the two denials that we did receive on these
items, I realize now, through all your input, we used the incorrect
diagnosis codes. We should have used 356.1 and did not. Ugh! Even though
all of the provider medical records indicate that the patient does have
Charcot Arthropathy they still are denying the appeal. Not sure they even
read the notes!!!

Maggie Perez
Office Manager
Capital O & P
246 Pleasant St
Concord, NH 03301
603-226-0106 Ext. 4187

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Capital Orthotics and Prosthetics, LLC
246 Pleasant Street, Suite 200, Concord, NH 03301
603-226-0106 / fax 603-226-0845
www.CapitalOandP.com

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