Just as my poll with my co-workers and friends, I received an array of
answers and reasons.
It ranged from the following:
– all custom plastic AFO/SMO designs that were rigid ankle
– all custom AFO’s
– Sablich trim lines
– peroneal notch and calcaneal bolsters to control hind foot
– mold modification buildups and then padded (not to be billed
with L-2820 BK padding)
– any modification to any FO, AFO, KAFO that can alter
varus/valgus
(Side note) – I had a few manufacturers post as well that mentioned
they are trying to communicate with Medicare on clarification of this
code for allowance in various branded devices.
Here are the copy and paste replies:
* I use the code when I am using a casting technique or a plaster
modification technique specifically to control varus, like stabilizing
the hindfoot and arch, or modifying the cast to increase control in that
area. The code includes padding in the area when this is done, so you
can’t use both L2275 and L2820 (soft interface).
* My understanding is that the L2275 was created to match the addition
of a sabolich trim on the mid to distal calf section to prevent a varus
or valgus moment. This is an actual “alteration” in the normal vertical
trim line that extends more anterior on the leg. It should be padded as
well. All things understood, that still doesn’t necessarily explain why
it can “never” be used on a leather/plastic gauntlet. Incidently, I do
agree that previous coding methods for the leather/plastic gauntlet
products was innappropriately being done and represented double billing.
* I view on this is for the modification and pad used for an ST pad as
taught by the old Oregon Orthotic System.
* Excellent question. I understand it to refer only to a fairly
agressive modification in a plaster mold. The modification is at the
sustentaculum tali region. I first learned of the code many years ago at
an OOS course, and have always associated it with an anatomical
modification style (often called “tone reducing”) as opposed to the
squared off, non-descript modification styles that are very common. In
my opinion, every patient requires an orthosis that conforms to,
supports, and corrects (as appropriate) the specific anatomical
structures of their foot (feet), so there is no plastic AFO that should
not include this modification.
I have seen it recommended as a code to describe an integrated plastic
heel post on an AFO, SMO, or UCBL, and have heard of it being used for
the peroneal arch modification, as well. These uses can result in more
than one quantity of that code being used per orthosis.
* I believe this code was developed to provide reimbursement for the
necessary modification(s) of a cast positive and the subsequent plastic
extensions needed in the use of the Sabloich type trim lines of a
thermoplastic ankle foot orthoses.
Furthermore, I believe this code should also be suitable for similar
modifications and or components
used in the provision of pre fabricated ankle foot orthoses that can
provide similar orthotic control as do the custom fabricated orthoses.
* If you consult the AOPA coding committee recs it should clarify. Our
use of the code is whenever a modification is performed, or a pad is
placed within a LE device that serves to control varis or valgus
deformities. Examples would be padded subtalar mods and padded Sabolich
flanges.
* I believe that this code is used when making a plastic AFO and you
have severe varus or valgus in the ankle. The trim of the AFO must
curve anteriorly, in front of the midline of the leg above the ankle to
put increased pressure on the medial tibia or the lateral fibula to
stabilize the ankle and not let it move into either varus or valgus. It
does not need to completely correct the problem but it should at least
help reduce it. Especially helpful with spasticity and can be used with
either hinged or solid ankle. I sometimes bring the anterior trim
distally over the ankle and below. If it’s tight enough to help, it
needs to be padded.
* I have always justified my L2275 by documenting a varus or valgus
condition that warrants the code. No varus/valgus – no code. I believe
we need to defend our coding options and must support it with
documentation as such. I know of facilities that routinely use this code
regardless of deformities. I believe this will be one of the next codes
we lose due to misuse.
* A medial or lateral flange superior to the maleoli. I have also
heard it being used as an external plastic post on an orthosis.
* I’ve asked this question many times myself. I’ve never been to a
coding and billing seminar, however people I’ve discussed this with
have. In my humble opinion, this code should be used whenever you are
taking an extra step in the normal modification process of L1970 or 1960
(or any custom AFO base code) in order to control varus valgus. This
could occur at numerous places in the lower extremity, knee, ankle,
midfoot and forefoot. But I feel the importance of billing this addition
is making a modification that is distinctive (ie. Sabloich trimline
proximal to ankle).
* It is proper to bill any code only when the feature or device it
describes is documented as medically necessary and the feature or device
was delivered to the patient. I always try to ask myself, “Would you be
comfortable defending this coding in an audit?”.
* My answer is…..the code do not make any sense. How can you control
varus/valgus correction when the forces it would take to generate this
fix is greater then a simple posting or butress? The area of correction
and the forces applied do not really correct ankle true ankle valgus or
varus. the code and language is not properly written to define what you
are turly after in ankle correction
* I use L-2275 whenever I am controlling motion in more than one plane,
either biplanar or triplanar control. I don’t care if padding is added
or not.
* It’s appropriate whenever corrective force is used, applied or
maintained to achieve the desired result or at least extra pressure
applied externally. Wether it is padded, modified in or held in place
during casting to aid in corrective modifications. If I have to make no
effort to control or infleuence the deformity, then I would not use the
code. Plastic posting for correction at the heel should also apply. I
have asked this a lot & I feel OK using it. Not sure why Arizona had a
problem.
* “Any” modification to a custom Molded orthosis intended to control
varus/valgus. Paraphrased from the 2005 illustrated guide by AOPA.
Coincides with the “T” strap used on a conventional orthosis. I use it
for wedges carved into models and posted on the brace to control
varus/valgus. Also for medial or lateral wings above malleolus. It does
seem to be broad, as long as it applies to a custom Molded orthosis (FO,
AFO, KAFO) and controls varus or valgus.
* I use the L2275 code if I alter the trimline AND alter the
modification of the plastic AKO/KAFO to control, support or influence
the varus/valgus of the body part distal to the joint
Thank you to everyone who replied.
James P. Cobb CO, BOCP
Gulf Coast Veterans Health Care System
Staff Orthotist/Prosthetist
