Hi List,
Here are the small amount of responses to the question of which codes are currently being used and paid for in region C for the CROW Walker. I appreciate your responses. I actually had many more people wanting the results than answered the question. Below are the resonses.
Here is the original posted question:
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Hi List,
I posted on Friday a question and had only 2 responses. I had 27 people that wanted the results. Please-those of you that supply the CROW or otherwise known as the Diabetic walker-respond to this inquiry.
Thanks,
M. Britt Spears- ABC-CPO-FL-LPO-AAS-CEO-CFO and many other initials that we’ll share later….
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Here it is again:::::::
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Hi List,
I’m curious as to what codes are being used and paid for by Medicare Region C on the CROW Walker with all the bells and whistles? I’ll be happy to post the responses or if you would prefer, I’ll keep your names off the responses-let me know which way you prefer.
Thanks,
M. Britt Spears CPO
www.Prosthetics-Orthotics.net
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I don’t see patients, or bill medicare but I do fabricate A LOT of
CROWs and
the codes I usualy suggest came from a freind here in region C who does
bill
them.
they are as follows:
1960
2340
2820
3002
3310
3400
I don’t have descriptions but if you have the book you can look them
up.
I would be interested to see how these compare to the rest of the
planet.
Tony Wickman RTOP
Freedom Fabrication inc.
800.304.3733
WWW.freedomfabrication.com
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Hello Brit,
Currently I am using L1960,L2340,L2755(if high strenght is involved),L2820,and a few FX socks if they want them.I don’t feel comfortable adding the rocker bottom Lcode.I usually have a removeable insole that is grond pretty flat so a small peice of diamond crepe is added on the bottom for a walking surface. I guess I am just a little gun shy about adding too many code in the wake of all of those denials. Hope this helps.
– Brian Moore CPO
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Hello! We bill for CROW walkers as follows:
CUSTOM FABRICATED AFO, SOLID ANKLE, FOR DIABETIC PTS L1960
SOFT LINING FOR PLASTIC BELOW KNEE SECTION L2820
PRE-TIBIAL SHELL-CUSTOM MOLDED TO PATIENT MODEL L2340
ROCKER SOLE L2999
INSERTS, CUSTOM MOLDED, PLASTIC L2999
LIFT, CREPE, HEEL AND SOLE, 1″ L2999
NON SKID SOLE L2999
Also, we have found that if you have a diagnosis code of an ulcer, we
are not being reimbursed.
🙂
Ellie Boomer, C.O.
Certified Orthotist & Prosthetic Resident
Marketing Specialist
Mary Free Bed O & P
[email protected]
(616)242-9293
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L2999 for the removable insole similar to L3010 or 3020, L1960, L2340,
l2820, L2999 similat to L3400. L2350 substituted for 2340 if you can
justify
locking down someones ankle and then trying to suspending them.
Varus/valgus if you can justify padding and pushing into a void on the
contralateral side of the pad. So few responses because this has been
on the
list before. Cannot be used for ulcer treatment per Medicare
guidelines.
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For a Medicare Diabetic
L 1960
L 2820
L 2350 or L 2340 ( One or the other, not both)
L 2250
A 5511
A 5503
Non-Medicare,
All of the above, take off the A codes and include L 3020 and L 3400
I hope this help’s
Brad McCully BSc ABC C.O. PFA C.Ped OM, HO ( literally) and some more that I could manufacture 😉
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I have learned the hard way on this one. I no longer accept assignment on CROW’s. I charge the price I think is fair up front, bill medicare for the patient and advise the patient not to expect much back. L1960, L2820, pretibial shell code, L2999 for insert, rocker etc. Medicare in region C will not pay the L2999 regardless of what you send them. Unfortunately we are applying this policy to more items every month. I truly think it is the only way to stay in business in this environment. I tell the patient to complain to their congressman if they have a problem with it. Food for thought.
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When I took AOPA’s Medicare Coding course (many years ago), I was told that, when in doubt, use the code that most closely describes what it is you’ve made. I make a Maintenance AFO for kids who have had serial casting. It’s basically a CROW with as much dorsiflexion range built into it that the kiddo can give me, has a rocker bottom sole, and is lined with 1/4″ aliplast. The following may seem like “creative coding” to the max, but I attach a lot of documentation/pictures to support it.
I use L2108 – Tibial Fracture Cast Orthosis, Custom Fabricated, L2820 – Soft Interface Lining, and L3400 – Rocker Bottom Sole. I write a letter of explanation to the insurance company regarding the lack of coding available for the MAFO, attach a copy of L2108 from AOPA’s Illustrated Guide to Orthotics & Prosthetics, highlight the language underneath the picture that states “An AFO… consisting of a circumferential tibial section which is custom fabricated” (I do not highlight “for the treatment of fractures”), and reiterate that this code comes closest to describing what it is I made, that the patient does not have a fractured tibia, but that the usage of this AFO design is appropriate for many other orthopedic conditions besides fractures. I also attach a picture of the patient wearing the orthosis and a brief write-up of the benefits, biomechanics, and how the patient will be using the MAFO.
Bottom line, I’m honest with the payer, they are educated about my coding dilema, they’re not having to pay for a heel cord lengthening surgery (or potential amputation in the case of a diabetic being fit with a CROW Boot), and I get paid a “somewhat” decent reimbursement. At all cost, I avoid L2999. It seems like the insurance companies think that I am pulling something out of thin air when I use L2999. They understand my reasoning when I use L2108.
I have not billed a Medicare claim for a CROW/MAFO, but I would do it the same way. What we obviously need is an LCode for a CROW Boot. I would be interested in practitioner feedback on using L2108 until we get one.
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