Dear List-Serve,
Here’s some “highlights” that I discovered in reading proposed future LCD
modifications.
It appears to be existing policy and I think we should seek to correct it.
Knee-ankle-foot orthoses (KAFO) described by codes L2000-L2038, L2126-L2136,
and L4370 are covered for ambulatory beneficiaries for whom an ankle-foot
orthosis is covered and for whom additional knee stability is required.
AFO’s are covered according to this LCD if:
Ankle-foot orthoses (AFO) described by codes L1900, L1902-L1990,
L2106-L2116, L4350, L4360, L4386, L4387 and L4631 are covered for ambulatory
beneficiaries with weakness or deformity of the foot and ankle, who:
1. 1. Require stabilization for medical reasons, and,
2. 2. Have the potential to benefit functionally.
So my conclusion is that extending a knee stabilizing orthosis down to the
foot for many good and sound reasons, in the absence of weakness or
deformity of the foot, will be considered not medically necessary and
denied.
I sometimes make KAFO’s to stabilize only the knee in either the frontal
and/or sagittal planes when I believe that the additional leverage obtained
by going down to the foot will improve the functionality of the orthosis, or
it will provide a sure and certain and fixed position of the orthosis on the
patient, or it will prevent the orthosis from slipping down the leg,
particularly in obese patients with conically shaped legs, or will reduce
the need to make the brace tighter than would otherwise be necessary to
control downward migration of the orthosis, or when such restriction might
create discomfort to the patient or compromise skin integrity and/or
circulation, when a consistent donning can be assured to those who are
incapable, either physically or mentally, of donning an orthosis correctly,
or to mitigate the force that would otherwise have to be applied to the
lower part of the limb (below the knee) because of concerns about pressure
intolerance. And I’m certain that there are other good reasons.
Where do we start?
Herb Shalant, C.P.O.
Innovative Orthotics & Prosthetics, Inc.
White Plains, NY
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