I need some help. I have applied to HCFA for a procedure code for a PSRD.
This is a polyethylene semi-rigid removable dressing ( see the Journal of
Prosthetics and Orthotics/Volume 5 Number 1/January 1993 by Vern M. Swasson,
CP ) We have been using this type of device more and more and as physicians
became aware of it they more and more insist on it. I’ve found that
amputees do one thing better than anyone else…. They fall down. Its
understandable given they are not used to only having one leg and usually are
sick, PVD and/or diabetic if not weak, nervous, or wearing one of those
slippery hospital socks (great for the balance). When a BK falls they
instinctively reach for the ground with the foot no longer there and land on
the end of the amputated limb (ouch). We all have seen this and either have
been faced with a difficult limb to fit or lengthy delays depending on the
injury. Doctors are eager to use the PSRD because it is so easy to remove
and keep clean and can be ventilated.
The problem is how to code it. L5450 is OK for Part A settings but Medicare
will not pay us in a Part B setting. I’ve found that more often than not
(62% of the time) we see new amputees in skilled nursing facilities and
nursing homes or other Part B settings.
Kay Riley at HCFA tells me she needs some numbers in order to consider the
code request. Since there is no way to track how many are being made I need
a random sampling. I need it fast. They are reviewing the request for the
last time on the 15th so I need it by the 11th . I need to know:
1. What is the annual sales volume.
2. Of the annual volume what is the percent in the following settings:
Physician’s office
Ambulatory care clinic
Patient’s home
Inpatient facility
Other
If this is not doable in such short notice please give me any of the
following:
1. How many you estimate in part A vs part B settings.
2. How many you would provide if there were a procedure code
