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Dx. Specific DME Protocols MPMA Summer Meeting

Dx. Specific DME Protocols MPMA Summer Meeting. Hal Ornstein, DPM, FACFAS Chairman, AAPPM 18 Years in Private Practice President of the Jeff Frederick Fan Club. REASONS TO FOLLOW THESE PROTOCOLS. Improved outcomes Easy to follow Medico-legal security Improved patient compliance

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Dx. Specific DME Protocols MPMA Summer Meeting

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  1. Dx. Specific DME ProtocolsMPMA Summer Meeting Hal Ornstein, DPM, FACFAS Chairman, AAPPM 18 Years in Private Practice President of the Jeff Frederick Fan Club

  2. REASONS TO FOLLOW THESE PROTOCOLS • Improved outcomes • Easy to follow • Medico-legal security • Improved patient compliance • Improved patient satisfaction • Patient convenience • Ease of inventorying • Consistent with standards of care

  3. Documentation Summary, Chart • Prescription or order • Documentation of Therapeutic Necessity • Signed Certification of Patient Receipt • Chart Notes of Dispense • Invoice

  4. Documentation Summary, Office Complaint Resolution Policy, Forms, Log Supplier Standards Warrantee Info Posted hours

  5. DME Codes L2999 Non covered L1902 AFO gauntlet style L1906 AFO multiligamentous L4386 AFO non-pneumatic walking L4396 AFO plantar fascia night splint L4360 AFO pneumatic below knee L1971 AFO with ankle joint L4350 AFO ankle control orthosis L1932 AFO dynamic L1951 AFO spiral, plastic, other

  6. DME Codes L1940, L2210, L2330, L2820 Arizona AFO, dynamic assist L1970, L2210, L2820 Richie AFO, dynamic assist L1940, L2330, L2820 Arizona AFO, standard L1970, L2820b Richie AFO L1940, L2330, L2820 Arizona AFO, tall L1960, L2340, L2820 Arizona AFO extended A5501, A5506, A5503 Custom molded shoes with rocker bottoms and offset heels L1940, L2330, L2820, A5501, A5506, A5503 Custom molded shoe with Arizona Standard AFO

  7. Plantar Fasciitis 728.71 Plantar fascial fibromatosis 718.47 Plantarflexion contracture of ankle

  8. Plantar fasciitis: Initial Visit PowerStep Insert Suggested Code: L2999 Patient Pays Aircast Airheel Suggested Code: L2999 Patient Pays

  9. Plantar fasciitis: Subsequent Visit Mild Ossur Exoform Ossur Formfit Ossur Airform Night Splint, posterior or dorsal Suggested Code: L4396 DMEPOS Fee Ceiling: $180

  10. Plantar fasciitis: Subsequent Visit Severe Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  11. Posterior Tibialis Tendonitis 726.72 Tibialis tendonitis 905.8 Late effect of tendon injury, sprain, strain

  12. Posterior Tibialis Tendonitis, Mild: Initial Visit Aircast Airlift PTTD Suggested Code: L1906 DMEPOS Fee Ceiling: $135 PowerStep Insert Suggested Code: L2999 Patient Pays

  13. Posterior Tibialis Tendonitis, Moderate: Initial Visit Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505

  14. Posterior Tibial Tendonitis: Severe, Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  15. Posterior Tibialis Strain, Moderate : Subsequent Visit Ossur Exoform Ossur Formfit Ossur Airform Night Splint, posterior or dorsal Suggested Code: L4396 DMEPOS Fee Ceiling: $180

  16. Posterior Tibialis, Rupture, Stage 3 727.68 Rupture, tendon of foot and ankle, non- traumatic 728.4 Laxity of ligament 734 Flat foot, acquired

  17. Posterior Tibialis Strain, Rupture, Stage 3: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  18. Posterior Tibialis Strain, Rupture, Stage 3: Subsequent Visit, if getting better Less Severe More Severe Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Aircast Airlift PTTD Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  19. Posterior Tibialis Strain, Rupture, Stage 3: Subsequent Visit, if getting worse Richie AFO Suggested Code: L1970, L2820 DMEPOS Fee Ceiling: $901 Arizona AFO Suggested Code: L1940, L2330, L2820 DMEPOS Fee Ceiling: $1099

  20. Ankle Sprain, Grade 1 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.00 Sprain and strain of ankle and foot, unspecified site 729.5 Pain in limb 719.07 Unspecified disorder of ankle and foot

  21. Ankle Sprain, Grade 1: Initial Visit Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  22. Ankle Sprain, Grade 2, 3 729.5 Ankle pain and support 719.07 Effusion of joint, ankle, foot 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.01 Sprain and strain of ankle and foot, deltoid ligament 824.2 Ankle fracture, lateral malleolus only 824.6 Ankle fracture, trimalleolar

  23. Ankle Sprain, Grade 2, 3: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  24. Ankle Sprain, Grade 2, 3: Follow up visit, 2 - 6 weeks Healing Well Delayed Healing Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505

  25. Pediatric Fracture 729.5 Ankle pain and support 719.07 Unspecified disorder of ankle and foot 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.01 Sprain and strain of ankle and foot, deltoid ligament 824.2 Ankle fracture, lateral malleolus only 824.6 Ankle fracture, trimalleolar

  26. Pediatric Fracture: Initial Visit Aircast SP Walker Aircast XP Walker Pneumatic Walker, Pediatric Size Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  27. Pediatric Fracture: Follow up visit, 7 - 9 weeks Aircast Air-Stirrup, pediatric size Suggested Code: L4350 DMEPOS Fee Ceiling: $100

  28. Ankle Instability 845.02 Sprain and strain of ankle and foot, calcaneofibular 845.00 Sprain and strain of ankle and foot, unspecified

  29. Ankle Instability: Initial Visit Moderate Mild Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505 Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  30. Tarsal Tunnel Syndrome 355.5 Tarsal tunnel syndrome 719.47 Pain in joint, ankle, foot

  31. Tarsal Tunnel Syndrome: Initial Visit Moderate Mild Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505

  32. Tarsal Tunnel Syndrome, severe: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  33. Peroneal Tendonitis ???? ?????

  34. Peroneal Tendonitis: Initial Visit Mild, Moderate Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  35. Peroneal Tendonitis, severe: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  36. Peroneal Tendonitis: Subsequent Visit Severe Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  37. Sinus Tarsi Syndrome 726.79 Enthesopathy of ankle and tarsus, other 719.47 Pain in joint, ankle, foot

  38. Sinus Tarsi Syndrome: Initial Visit Moderate Mild Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135 Donjoy Velocity ES Suggested Code: L1971 DMEPOS Fee Ceiling: $505

  39. Sinus Tarsi Syndrome: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  40. Severe Sinus Tarsi Syndrome: Subsequent Visit Ossur Gameday Suggested Code: L1906 DMEPOS Fee Ceiling: $135

  41. Drop Foot 736.79 Acquired deformity of foot and ankle 438.20 Hemiplegia 719.97 Joint derangement, ankle and foot 356.1 Peroneal muscle atrophy, Charcot Marie Tooth disease 340 Multiple sclerosis 138 Poliomyelitis, late effects 728.85 Spasm of muscle

  42. Flaccid Drop Foot : Initial Visit Ossur Dynamic Suggested Code: L1951 DMEPOS Fee Ceiling: $905 Euro International Peromax Suggested Code: L1932 DMEPOS Fee Ceiling: $962

  43. Spastic Drop Foot : Initial Visit Richie Dynamic Assist Suggested Code: L1970, L2210, L2820 DMEPOS Fee Ceiling: $976 Arizona Dorsiflex Assist Suggested Code: L1940, L2210, L2330, L2820 DMEPOS Fee Ceiling: $1174

  44. Rigid Equinovarus • 736.71 Equinovarus, acquired • 754.51 Equinovarus, congenital • 728.85 Spasm of muscle

  45. Rigid Equinovarus: Initial Visit Arizona AFO, Tall, foot plate to sulcus Suggested Code: L1940, L2330, L2820 DMEPOS Fee Ceiling: $1099 Arizona AFO, Extended Suggested Code: L1960, L2330, L2820 DMEPOS Fee Ceiling: $1179

  46. Achilles Tendonitis, Achilles Tendon Tear 845.09 Achilles tendon strain, tear 726.71 Achilles tendonitis

  47. Achilles Tendonitis, Achilles Tendon Tear: Initial Visit Ossur Equalizer Premium Ossur Equalizer Low Top Aircast SP Walker Aircast FP Walker Pneumatic Walker Suggested Code: L4360 DMEPOS Fee Ceiling: $312

  48. Achilles Tendonitis, Achilles Tendon Tear: Second visit Ossur Exoform Ossur Airform Ossur Formfit Night Splint, posterior or dorsal Suggested Code: L4396 DMEPOS Fee Ceiling: $180

  49. Achilles Tendonitis, Achilles Tendon Tear: Follow up visit Bauerfeind Achilleotrain Suggested Code: L1902 DMEPOS Fee Ceiling: $90.11

  50. Metatarsal Fracture 733.10 Stress fracture, unspecified 825.25 Fracture of the metatarsal bone

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