Wednesday, May 25, 2022

fun with coding responses-1

Troy Fink, CO

I received 30 responses to my question asking you to code a pictured AFO.
Thanks to all who took the time to respond. I have tallied the responses. And the
winners are:

L1970 custom molded articulated AFO 30*
L2275 Valgus plastic modification 22*
L2200 (x1) limited motion ankle, ea. joint 15*
L2270 valgus T-strap, malleolus pad 8*
L2200 (x2) limited motion ankle, ea. joint 6
L2770 (x1) any material, (stainless steel) per joint 6
L2770 (x2) any material, (stainless steel) per joint 6*
L2820 soft interface, below knee 4
L2220 (x2) dorsi & plantar assist/resist, ea. joint 3
L2999 hallux pad (forefoot internal post) 3
L2999 external heel post 2
L2210 dorsi assist/plantar resist, ea. joint 1
L2220 (x1) dorsi & plantar assist/resist, ea. joint 1
L2250 custom molded footplate w/ stirrup 1
L2360 extended steel shank (full length footplate) 1
L2999 full length footplate 1
L3580 convert shoe to Velcro closure (dorsum strap?) 1
L2999 dorsum strap 1
L2999 proximal pre-tibial strap 1

*These are the codes I consistently use. I sometimes have to make a
justification for the stainless steel joints (e.g., pts. weight, need to resist motion
in the transverse plane, need to resist compressive forces of dorsi-stop as
polyurethane and aluminum will likely fail). I’ve also had to justify the
apparent redundancy of using a dorsum valgus control strap in conjunction with a
padded plastic valgus mod. I explain that 1) although they are working to achieve
the same goal, they are acting on different locations 2) one is static and
the other dynamic and 3) considerable force is required to maintain the
corrected alignment of the hind foot–the pressure is reduced by increasing the
contact area.

Scroll down for my original post and the full responses.

Thanks again,

Troy Fink, CO
+++++++++++++++++++++++++++++++++++++++++++++++++
ORIGINAL POST:
Hi

Coding an AFO should be pretty easy (at least easier than a Donjoy or
Townsend KO), but I have a local HMO that has their own ideas on the topic. I would
like to get some input from the other LISTSERV subscribers as how to correctly
code this AFO.

I’ve created a webpage with pictures of the AFO and a link back to my email.
Please take a look at it and let me know what codes you would use. I’ll
compile and post the results in a few days. I will not include the names of the
respondents, so please try to be candid and honest. It will benefit us all.

Go Here: http://ourworld.cs.com/Braceguy1/coding.html

Thanks,

Troy Fink, CO
Latham, NY

+++++++++++++++++++++++++++++++++++++++++++++++++
RESPONSES:
=================
L1970, L2220 x2, L2275, L2770x2.
============================
I would use L1970. This will save money and I could never be accused of
un-bundling.
================================
Here are the codes I would suggest for this AFO. When I was in clinical

practice this is how I would have billed it out.

L1970 Articulated AFO

L2000 x 1 Limited motion joint (There is only one device causing limited

motion)

L2275 Valgus/Varus corrective plastic

The x 1 on the 2000 is what AOPA recommended when I went through their

billing seminar a few years back.

Let me know if there is anything else that I can help you with.
=================================
I would code this as the following:

Articulated AFO L1970 X1

Valgus modifications L2275 X1

Steel Joints L2270 ?? X2

Limited motion ankle joint L2200 X1

Possible external heel post L2999 X1

All must be medically justified
=========================
I would code this way,

L1970LT 1ea

L2220LT 2ea if I rationalize that the DF resist applies to both joints

L2270LT 1ea for strap

L2275LT Varus corr. padded/lined

L2270LT 2ea stainless jts

L1970; AFO, plastic, w/ free ankle joint, custom

L2250; Add Foot plate, molded, stirrup attachment; – because of the added work

L2270; Add Varus / valgus correction (T-strap), padded / lined or malleous pad

L2200; Limited motion ankle joint – the posterior strap limits the motion of
the ankle joint
=======================
L 1970 x1

L 2200 x1

L 2275 x1

L-1970 x 1

L-2220 x 2

L-2275 x 1

possible…depends L-22?? lined lower extremity

forget the code here at the house…
========================
I would code it as an L1970 (base code), (1) L2200 for limited motion ankle

joint, (1) L2275 (I think that is varus/valgus plastic control, (1) L2270 (

I think that is varus /valgus T-strap. I’m doing this from home without any

manuals so forgive me if I’m incorrect with the L codes. I think the

important thing is to document why you feel it is necessary for to types of

varus/valgus control. I generally only code for one or the other.
==========================
L1970 X 1

L2275 X 1

L2270 X 1

L2200 X 2

I assume the joints are included in the L1970 code as they are free motion.
I only use one L2200 rather than two per orthosis. If I had a pf stop I
would use a quantity of two. The ankle strap appears to pull laterally so it
qualifies as a t strap. The trimlines and padding suggest valgus control
modifications to positive mold. I don’t charge for the padded tibial strap or the
small amount of padding under the toe. If the entire footplate was lined before
the pull I would use L2820.
===================

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