Original post:
Has anyone heard of the Orthotrac pneumatic vest support?
(www.orthofix.com
wearable product that achieves spinal offloading”. Is consists of
pelvic and lower thoracic components connected by pneumatic cylinders
that separate the components when pumped up. They apparently don’t like
to sell to O and P offices because they want to charge about the same
as their retail price which exceeds Medicare allowable for a Raney
Flexion jacket. It doesn’t appear to provide abdominal compression, just
distraction, so they claim. Why they call it a “vest”, I don’t know,
and I’m not aware of an approved L code for it.
We are being asked by the IPA to purchase it and fit it to a patient,
but I don’t feel comfortable charging what an appropriate mark up would
require.
Does anyone have experience with it?
Randy
(Sorry I neglected to include my full name and credentials in this post)
Responses: (each separated by a blank line)
I have an Orthofix rep in my area that sell these braces directly to the
patients in their home. He gets his referrals from a couple of
neurosurgeons and ortho surgeons. The patients are usually self-pay or
work comp as I understand. He does bill the insurance companies on
occasion and has not to date given me L codes. I do know that he wears
the brace himself when needed. From what I recall it is quite bulky and
weighs approx 3 lbs.
I had an Orthopaedic surgeon contact me last month to fit one. I saw it
(via the rep). The company would not let me measure, order or fit it.
The reps do all the work and the company bills for it. I asked how
could I ever fit one. They said I would have to attend training. After
training I would have to fit a set amount of them with the rep before
they will sell directly to me. All of this in mind, we still can’t get
fully reimbursed for it. I just let the rep deal directly with the
doctor. The doctor was fine with it. It’s also funny how he hasn’t
ordered any more. The patients compliance changed his mind on using
this “vest”.
I have had some horrible dealing with these folks. They suggest and bill
under the old L0430 code. Clearly it is not a TLSO. They are correct
that it is the only “off loading orthoses” available, but what they
usually fail to share is that it is only worn for short periods of time
(I believe 20 minutes). I have worn them and feel I get simmilar relief
with a cyber tech or the Prolign (deroyal) if I apply it supine
position. They can be worn most if not all day and can be legally and
you can make some money as well.
Sorry to say I had two positive experiences before they yanked the
product away from us. Good luck to them in my state. Unless they have
a certified individual doing the fittings, they can’t do any of the HMOs
BCBS or Medicaid. And, I’m not sure the patients will want to pay their
copays even if they have Medicare.
I had a patient ask me to order an Orthotrak vest for his DDD and was
told by the rep, who regularly measures, fabricates, fits, and repairs
these “custom made” devices that Medicare doesn’t pay for them yet but
that they do have an E-code assigned to it. I don’t remember the exact
code, but it was one in the neighborhood of the cervical and lumbar
traction devices.
Orthofix rep said they weren’t selling to any O&P shops yet until they
found out what allowable MCare was going to assign it. Rep claims that
once MCARE starts paying, they expected that the “kits” to fabricate the
device will be available. The idea is to make it so the device is
measured, fabricated, and dispensed at the patient’s initial visit.
Other than seeing a model on the rep, I have no experience with
measuring, fabricating, or fitting the unit. However, it doesn’t seem
difficult.
I must ask myself sometimes why, when one has access to the web, one
asks the list server where to find something rather than just typing in
the name into the search box. Also please try to remember to add your
credentials to your name.
I can tell you that any patient lacking bony proms. to anchor to will
likely not be satisfied with the results as I anticipate the device will
simply move around the soft tissue. And conversely, any patient WITH
significant bony proms will likely have pressure issues since the inner
lining is quite firm.If you haven’t yet, ask the rep to bring one in to
show.
