Thursday, May 26, 2022

Molded to patient model???

I was asked last week to consult with an elderly diabetic AKA at the Ohio

State University prosthetic clinic. This patient had a new but extremely

poorly fitted prosthesis which she was unable to wear. It was fabricated for

her by a prosthetist “who came out and took some measurements and delivered

the prosthesis a couple of days later”. I explained to her that a cast of her

residual limb would be required for a socket replacement and she again told me

that the other prosthetist only took measurements.

The socket (an attempt at ischial containment) was so poorly designed that the

I.T. was well above the posterior brim and the socket was internally rotated

to such an extent that the adductor longus was 2 cm. from it’s channel.

My question is does this constitute fraud using HCFA guidelines? The

descriptors clearly state “molded from patient model”. Does “CAD by the

numbers” meet these guidelines?

I know is is becoming common practice for many facilities to order sockets

(and orthoses) which are measurement based and are not created from either a

custom impression or virtual casting system. In reality, I have seen some of

them fit rather well, however, It seems to me that this is not the issue

What is the feeling of the group? Does a measurement based prosthesis or

orthosis meet the “molded from patient model” guidelines? Do we need new “L

Codes” for measurement based systems?

I look forward to your response.

Ron Kidd, CPO

American Orthotic & Prosthetic Lab., Inc.

Columbus, Ohio


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