Tuesday, November 29, 2022

Crow Boot L-Codes

JIM Marshall

Thank you to all list members who responded to my posted query re: L-Codes for
billing the Crow Boot or Crow Walker.   I received at total of (14) responses as
of Noon PDT today.  Of those responses, (2) requested that I post the responses,
(10) responded that as of 2011, there is a single Medicare code:

L-4631that is designated for billing the Crow Walker and (2) reponses provided
the same set of L-Codes for billing the Crow Walker.  I suspect that these
latter two responses were the L-Code set used prior to establishment of the
L-4631 code.

The most comprehensive and helpful response re: the L-4631 code was provided by
Christopher Moore L/CPO from Adapt Prosthetics and Orthotics in Coeur d’Alene,
ID and is copied below:

L4631
 
from:
https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/ankle-foot_knee-ankle-foot_orthosis.htm

 
“Code L4631 describes a Charcot’s restraint orthotic walker (CROW) orthosis.
Code L4631 is a custom fabricated ankle-foot orthosis which has all of the
following characteristics:

1. Designed to maintain the foot at a fixed position of 0° (i.e., perpendicular
to the lower leg); and

2. Allows for varus or valgus deformity correction; and

3. Contains a rocker bottom sole with a custom arch support; and

4. Incorporates a rigid anterior tibial shell; and

5. Used by a patient who is ambulatory; and

6. Has a soft interface.
Code L4631 includes all additions including straps and closures. No additional
codes may be billed with code L4631.”

The most comprehensive response re: the “set” of L-Codes used for billing the
Crow Walker was provided by Don Pierson, CO, C. Ped from Arizona AFO and is
copied below:

This is off the PDAC website:

The Charcot Restraint Orthotic Walker, also referred to as CROW boot or walker,
was developed for patients with severe deformity of the foot and ankle due to a
sensory neuropathic arthropathy – most commonly caused by diabetes. The device
is a bi-valved copolymer full foot enclosure, totally encapsulated around the
ankle and foot with a rocker bottom sole built into the device. The orthosis is
custom fabricated to a positive model made from an impression of the patient’s
affected limb. It is fully lined and uses a custom foot insert. Appropriate
modifications are performed to the impression, which permits for equal weight
distribution through the limb and provides support of the ankle joint, tibia,
and fibula. The CROW boot can be modified to accommodate changes by flaring,
adding padding, and trimming where and when appropriate.

A CROW boot is billed using the following codes:

L1960 ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED
L2232 ADDITION TO LOWER EXTREMITY ORTHOSIS, ROCKER BOTTOM FOR TOTAL CONTACT
ANKLE FOOTORTHOSIS, FOR CUSTOM FABRICATED ORTHOSIS ONLY

L2275 ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION, PLASTIC
MODIFICATION, PADDED/LINED

L2340 ADDITION TO LOWER EXTREMITY, PRE-TIBIAL SHELL, MOLDED TO PATIENT MODEL
L2820 ADDITION TO LOWER EXTREMITY ORTHOSIS, SOFT INTERFACE FOR MOLDED PLASTIC,
BELOW KNEE SECTION

L3010 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH
SUPPORT, EACH

No other codes may be billed for a CROW boot. There is no separate billing for
any modifications, fitting, or adjustments.

Thank you to all who responded for your helpful input.

Best Regards,

Jim Marshall, Practice Owner
Collier Rehabilitatio Systems
Pleasant Hill, CA

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