ORIGINAL POST:
It’s my understanding that L4386 is used for a prefab CAM walker. Is it
ever appropriate to use a different code for that device, say if it was
prescribed as a prefab tibial fracture orthosis, L2114?
I’ll post replies.
Thanks,
Randy McFarland, CPO
Fullerton, CA
RESPONSES:
It is L4386 for non-pneumatic and L4360 for pneumatic.
My understanding is L4386 and L4380 (for pneumatic versions)are to be
used for any diagnosis other than a fx. I do not believe medicare pays
for L2114 period. Private insurances and medicaid do pay for L2114 for
tibial fx diagnoses. This is my best understanding.
L2114! Absolutely! If the orthosis is prescribed for any type of
fracture in the lower leg or foot, it should be coded for what it is.
Nothing more, nothing less. The expertise required to evaluate and
treat a fracture using a prescribed fracture orthosis is inclusive in
the 2114 code
ITS MY UNDERSTANDING THAT A FX BRACE CODE COULD BE USED IF THERE IS A
FX. IF ITS JUST A SPRAIN THEN THE OTHER CODE WBE USED
I used L2112 in the past but now restrict it to the 4396 or 4360 codes.
If I have a tib fib fracture and put a lot of time into it, I’d consider
using 2112. I’d have a hard time explaining it to Medicare though.
It also makes sense to use L4360 as this describes a walking boot with
or without air bladders and with or without joints. depending on the
boot used, one could also justify use of L2116, rigid tibial fx brace,
pre-fabricated. as always, code for what you provide, and provide what
you code. If you aren’t comfortable justifying this code to your mom, it
probably ain’t right.
It’s my position L4396 is appropriate for PRAFO/Multipodus boots only,
not boot walkers. As with all devices, doesn’t matter what’s written on
Rx or what the diagnosis is, coding is based on description of device
only. In spring of 2004 region D clearly stated ALL prefab boots should
NEVER be coded with AFO codes including the L21-series and SHOULD be
coded with L4360 for pneumatic and L4386 for non-pneumatic, with or
without joints and/or soft interface. Consider your cost for prefab
boots (anywhere from $30-$125), then review reimbursements for L2100
series and L4360 & L4386. We have a local DME provider billing L2112-4
through consignment closets. In most instances they’re charging insurers
upwards of $800 for $25 boots, never having seen patient. Resist the
urge.
L4386-Non-pneumatic walking boot, with or without joints, with or
without soft interface. Have a look:
www.cignamedicare.com/dmerc/dlog/dlog2004/spring_2004/040210a.html
http://forum.repoc.northwestern.edu Randy, please check out this site
and give them the benefit of your input!
The code for a non pneumatic cam walker is L4386 the codes for tibial
fracture afo’s are specific to the type of orthosis and diagnosis. The
only time the L2112 or 2114 are used is when the orthosis is set up for
fracture care which would include anterior and posterior panels. In
addition the DMERC’s are reviewing those codes for possible abuse.
Better to stick with the L4386 and only use the other codes when doing
fracture care.
Years ago when I attended the AOPA coding seminar I asked the question
about what L code to use for certain orthosis and if is based on
diagnosis. For example, at that time, I specifically asked about a KAFO
used to treat a fracture or treat knee instability using codes L2128 or
L2036. This orthosis could actually be identical in construction,
components, and fabrication. But the base code selection is based on
diagnosis alone. The similar question is raised with tibial fracture
braces or CAM Walkers. Do you use L4386 or L2114? Do you use L4386
anytime you fit a CAM Walker? Or do you use L2114 if you fit a CAM
Walker on a tibial fracture? The physicians are prescribing CAM boots
for tibial fractures, they are not prescribing the Sarmiento type
prefabbed braces. Therefore, based on diagnosis we have an order for a
brace which fits AOPA’s description and interpretation and is prescribed
by a physician.My clinical staff and I have discussed this issue and
have raised both business and ethical points. There are facts which need
to be clarified. Please post your responses.
It is L4386 for non-pneumatic and L4360 for pneumatic.
L2114! Absolutely! If the orthosis is prescribed for any type of
fracture in the lower leg or foot, it should be coded for what it is.
Nothing more, nothing less. The expertise required to evaluate and
treat a fracture using a prescribed fracture orthosis is inclusive in
the 2114 code.
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