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That Daily Shower Can Be a Killer

fall-in-showerBy JARED DIAMOND
Published: January 28, 2013 in the New York Times

The other morning, I escaped unscathed from a dangerous situation. No, an armed robber didn’t break into my house, nor did I find myself face to face with a mountain lion during my bird walk. What I survived was my daily shower.

You see, falls are a common cause of death in older people like me. (I’m 75.) Among my wife’s and my circle of close friends over the age of 70, one became crippled for life, one broke a shoulder and one broke a leg in falls on the sidewalk. One fell down the stairs, and another may not survive a recent fall.

Continue Reading on the New York Times website

 

Good Ulcer Management Reduces Amputation Caused by Diabetes

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Amputations caused by diabetic complications can be reduced by at least 50%with the use of proper shoe inserts, podiatry care and regular health checkups, according to a study that will be presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India from Feb. 4-7.

The study, conducted by researchers at the University of Gothenburg’s Sahlgrenska Academy in Gothenburg, Sweden, included 114 patients with diabetes who were at risk for developing ulcers. Each participant wore one of three shoe insoles and was monitored over a 2-year period. The researchers found that only 0 cialis pas cher france.9% of the participants developed a new ulcer during the first year.

Continue Reading on Healio.com

 

Study: Diabetic Footwear Not Worn at Home

Patients with diabetes prescribed to wear custom footwear infrequently wear this footwear at home where the largest amount of walking occurs, according to study results recently published in Diabetes Care.

The study included 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer and custom-made footwear. The researchers monitored footwear use with a shoe-mounted, temperature-based monitor and daily step count with an activity monitor worn on the ankle over a period of 7 consecutive days. Adherence was calculated as the percentage of steps that prescription footwear was worn.

Continue Reading on Healio.com

 

AFO Height Requirement Removed: Here’s the Latest on How to Appropriately Bill Prefabricated and Custom Fabricated Devices

The Medicare height requirement for AFOs that became effective January 1, 2013 has been removed.  Billing of prefabricated and custom gauntlets and AFOs remains, as it was, last year.

Some AFOs were unaffected by the January 1 change, some devices were affected but are now not impacted and other AFOs are still subject by earlier policy changes.

The following is a summary of where things stand in February 2013.  DPMs are reminded to include in their documentation the rationale for prescribing the specific device to be supplied/dispensed.  As always, the final and sole responsibility for correct coding, within established laws, rules and standards of practice, rests upon the party submitting the claim.

 

L1902, “AFO ankle gauntlet, prefabricated”

Not required to have PDAC verification nor need extend as high as to near the fibular head.
The 2013 fee schedule ranges, depending on the state, from $69 to $92.

Examples, recommended by the manufacturers and by SafeStep to be billed as such include:

Ossur Gameday, Exoform
Aircast A60
Darco Web, Sport, Pro
Medspec ASO
SafeStep DME Multiligamentous Sport

 

L1906, “AFO multiligamentous ankle, prefabricated”

Since 7/1/2012, are the only AFO required to have, active PDAC verification and are defined to have “a hinged ankle and a rigid stirrup and foot plate which provides functional tracking of the ankle with hind-foot and mid-foot stability during ambulation.”.

The 2013 fee schedule ranges, depending on the state, from $104 to $241.

Examples of such devices with active PDAC verification include:

Darco Body Armor Vario
Medspec EVO Hinge
Swede-O Arch Lok, Atom, Dorsi-Assist
United Surgical Trailblazer Hinged Ankle
Ossur Rebound

DPMs are advised to consult the PDAC website, www.dmepdac.com to ensure that PDAC verification is present and active. There are products that have design features to qualify as L1906 but have not had PDAC revalidation, as required, subsequent to last year’s Policy change.  The above list is as of 2/7/2013 and is subject to change. For a complete list of L1906 devices with effective L1906 verification click:

https://www.dmepdac.com/dmecsapp/do/productsearch

 

L1907, “AFO supramalleolar, with straps”

PDAC verification not required.
The 2013 fee schedule for such devices ranges, depending on the state, from $512 to $564.

 

L1930, “AFO plastic or other material, prefabricated”

No longer required to extend as high as the just below the fibular head.
PDAC verification not required.
The 2013 fee schedule for such devices, depending on the state, range from $170 to $326.

Examples recommended by the manufacturers and by SafeStep to be billed as such include:

FLA Orthopedics Foot Drop Splint
Ossur
Ossur
FLA
AFO Light
AFO Leaf Spring
Foot Drop Splint

 

L1951, “AFO, spiral plastic or other material, prefabricated”

No longer required to extend to just below the fibular head.
PDAC verification not required.
The 2013 fee schedule for such devices ranges, depending on the state, from $765 to $841.

Example recommended by the manufacturer and by SafeStep to be billed as such:

Eurointernational             Perosupport (formerly Peromax)

 

L1971, “AFO with ankle joint, prefabricated”

PDAC verification is not required. No longer required to extend to just below the fibular head.
The 2013 fee schedule ranges, depending on the state, ranges from $427 to $469.

Examples recommended by the manufacturers and by SafeStep to be billed as such include:

Ossur Rebound
DJO Velocity
Swede-O SureStep
Bledsoe Axiom

 

L2340, “pre-tibial shell, molded to patient model”

According to the January 2013 Policy Article, “a pre-tibial shell, custom fabricated, provides a rigid overlapping interlocking anterior tibial control between the tibial tuberosity to a point no greater than 3 inches proximal to the medial malleolus. The pre-tibial shell can be constructed from thermosetting materials, thermoplastics, or composite type materials.”

PDAC verification not required.
The 2013 fee schedule, depending on the state, ranges from $390 to $582.

 

L4350, “ankle control orthosis, stirrup style, rigid”

PDAC verification is not required. Unaffected by the recent Policy Article.
The 2013 fee schedule ranges, depending on the state, from $78 to $147.

Examples recommended by the manufacturers and by SafeStep to be billed as such include:

Ossur Formfit, Airform Universal
Aircast Airlift PTTD, Airsport, Air Stirrup
SafeStep  DME Air Stirrup, Foam Stirrup
Swede-O Versi-Splint

 

L4361, “AFO walking boot type, varus / valgus correction (CROW)”

Defined by LCD revision of 1/1/2011.
The 2013 fee schedule ranges, depending on the state, from $1400 to $1931.

 

L4386, “Walking boot, non-pneumatic”

Unaffected by the recent Policy Article.
The 2013 fee schedule for such devices ranges, depending on the state, from $144 to $158.

 

L4396, “static or dynamic AFO including soft interface, adjustable for fit, for positioning, minimal ambulation, prefabricated”

(Plantar fascia night splints)
Must as of 1/1/10 have adjustability. Many dorsal night splints commonly billed using this code lack “adjustably for fit” and so do not qualify for Medicare reimbursement. This item is an exception in that while others AFOs need be for ambulation, L4396 needs not when used for treatment of plantar fasciitis (728.71) or as part of a treatment plan for plantar flexion contracture of 10 degrees or greater (718.47).

The 2013 fee schedule ranges, depending on the state, from $150 to $183.

 

Arizona-type AFO / Moore Balance Brace

PDAC verification and an Advisory Article remain in place for Arizona AFO type custom gauntlets. According to PDAC, Arizona Short and Arizona Tall, or similar custom fabricated braces (including the Moore Balance Brace), only the following codes should be used:

  • L1940 Ankle foot orthosis, plastic or other material, custom fabricated
  • L2330 Addition to lower extremity, lacer or Velcro closure, molded to patient model, for custom fabricated orthosis only
  • L2820 Addition to lower extremity orthosis, soft interface for molded plastic below knee section
  • The 2013 fee schedule ranges, depending on the state, from $850 to $1389.
  • For the Arizona Extended and the Arizona Unweighting or similar custom fabricated braces, only the following codes should be used:
  • L1960 Ankle foot orthosis, posterior solid ankle, plastic, custom-fabricated
  • L2330 Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only
  • L2820 Addition to lower extremity orthosis, soft interface for molded plastic below knee section

The 2013 fee schedule ranges, depending on the state, from $902 to $1484.

 

Thermoplastic hinged articulated AFO

Devices that meet the description as L1970, “AFO, plastic with ankle joint, custom fabricated” are no longer required extend to within 4 cm of the fibular head. When they include a soft interface, code L2820 can also be billed.

The 2013 fee schedule for such devices ranges, depending on the state, from $621 to $929.

 

SafeStep presents a free live webinar on DME Treatment Protocols that includes all the latest coding and compliance issues.  To see the schedule and to register, CLICK HERE.

Your comments are welcome and appreciated. Updates relating to this and other coding, billing and compliance issues will be posted on the SafeStep blog, www.safestepblog.net.

 

Josh White, DPM, CPed

Joshwhite@safestep.net

 

Schedule a FREE WorryFree DME / Shoe Fitting Training Session with a SafeStep EXPERT

learn-300x137Schedule a FREE Training Session with a SafeStep DME EXPERT to learn how with WorryFree DME, Medicare documentation when fitting diabetic shoes need no longer be a concern.

SafeStep Training Sessions are designed to help your practice grow.  Schedule a FREE one-on-one personalized on-line appointment with one of our trained EXPERTS to make fitting diabetic shoes an important part of your practice.  In one 45-minute session, you will cover:

  • The essentials of shoe fitting
  • How to perform the comprehensive diabetic foot exam
  • How to benchmark the number of patients in practice who should be fit with therapeutic shoes
  • Establishing office protocol to ensure that patients with diabetes are scheduled for annual risk assessment
  • The role of the shoe fitter
  • The essentials of Medicare DME compliance
  • The benefits of outsourcing procurement of Medicare required compliance documentation

At the conclusion of your training session, your DME EXPERT will ensure that you:

  • Determine your “Number”, the number of patients in your practice with Medicare and diabetes.
  • Your office is set up for shoe fitting success
  • Can track your practice shoe fitting success using the SafeStep Practice Report Card
  • Determine if it would be beneficial to utilize free electronic billing to Medicare
  • Know where more assistance is available.
  • Schedule a follow-up appointment for additional training.
  • Earn your PQRS incentive bonus from Medicare

SafeStep DME Training is intended to help you grow your practice, improve patient care and enhance practice revenue.

Call 866.712.7837 or email us at info@safestep.net to schedule your FREE individualized on-line session!

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