Ron
I’m just getting to my mail and would also like to reply. I think you’ve
touched on a great example of how the present coding system can be difficult
to apply to some modern techniques. The language used in the prosthetic base
codes is “molded socket” where many of the orthotic codes use “molded to
patient model” or just “molded to model”. Whether there is a difference
between them is not certain and would probably only be really tested by a
contest between a provider and a payor. The vagueness and the inconsistancies
of the HCFA language is a double edged sword. Some believe it is designed
that way and gives us a degree discresionary latitude to apply the codes to
multiple things for the sake of being economical. But it is this discretion
that can be so inconsistant and misunderstood that it gets us in trouble.
Without clear guidelines we are left to hope we are not doing something that
is wrong in the payor’s eyes. We must keep in mind that we alone are
responsible for how we code and how much we charge. We have to be able to
defend both of these assuming one foot is in the office and the other on the
witness stand in front of our peers. The prosthetic base codes were written
long before CAD not to mention ICEX or whatever else will come along and tempt
these code’s usage. I think now is the time to be conservative with the codes
and listen carefully to your heart. Investigations in healthcare fraud is very
much on the rise and leaning too heavily on our coding system may just be what
gets those unlucky of us into trouble.
Keith Cornell CP
Cornell Orthotics & Prosthetics
