Codes A5500 (For diabetics only, fitting [including follow-up], custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert[s], per shoe) and A5513 (For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer or higher, includes arch filler and other shaping material, custom fabricated, each) correctly apply to footwear prescribed for diabetic Medicare patients. Debbie Sutter, who is our full time Certified Pedorthist, is our onsite professional looking out for you, your safety and comfort in selecting the correct footware customized for you. 100-2, Chapter 15, Section 130), the Medicare Claims Processing Manual (Internet-only Pub. In patients with diabetes, blood flow to the feet may be impaired. The patented X-Sole Relief Technology is designed to reduce load on the knee. Flat Feet Flat feet are a common condition. You will feel better and walk better because the nerves are actually healing.
To do so, enter the last four digits of the HCPCS code. Insurance We accept the assignment of most major insurance companies. It’s about providing clients with the tools—or shoes—so they can continue to ski, cycle, walk, or run while reducing their susceptibility to injuries or pain. More like a shoe doctor rather than a shoe store as we’ve become accustomed too :). A little wit Will serve to make our play Art. The beginning of the appointment is evaluation and assessment (not a diagnosis). Twenty-five percent of persons with diabetes develop foot problems related to the disease.
A: In the LCD under the policy-specific documentation requirements, under the miscellaneous section it states: For custom fabricated orthoses, there must be detailed documentation in the treating physician’s records to support the medical necessity of custom fabricated rather than a prefabricated orthoses. This water that is drawn to the nerve causes swelling. VA Hospital, Hines, IL: Rodney M. Medical Review staff is not only looking at the practitioner’s documentation, the physician needs to document that as well. Some doctors are not furnishing these progress notes or the progress notes are incomplete. Q: A supplier provided a fitting for a beneficiary for an orthotic and later that day, the beneficiary was admitted to the hospital. What information is needed in order to request a redetermination?
He was the Pedorthist on staff at AA-EE Shoes in Rolling Meadows for 12 years and has seen the most difficult problems that people face with their feet including Plantar Fasciitis, Bunions, Arthritis, Post Tibial Tendonitis, Neuropathy, Callouses, complications from Rheumatoid Arthritis or Diabetes. There was an article in the most recent Medical Economics talking about how many more hours we are all spending doing the busy work associated with patient care. Read More… Q: In the situation that a prosthesis is being replaced, do these get pulled for review and the physician acknowledges that the amputee is still at a functional capacity to require that level of prosthetic function that the medical review staff would allow this? JadeInTheMoon THAT LOOKS JUST LIKE HIM! Deltona-Daytona Beach-Ormond Beach, FL 5180W ATLANTIC AVE 107, Delray Beach, FL 33484 AM-MED DIABETIC SUPPLIES, INC. A: Per the LCD , “The certifying physician must be an M.D.
His life’s safaris have included everything from big-game hunting in South Africa to chasing his 3 children through a castle in DisneyWorld. and may not be a podiatrist, physician assistant, nurse practitioner, or clinical nurse specialist.” Medicare law allows for a Nurse Practitioner to order DMEPOS items, however in order to qualify a beneficiary for Therapeutic shoes the SSA 1861(s)(12) only allows for a physician (MD or DO) to be managing the beneficiary’s diabetic condition and to certify the need for shoes. In the classification of De Candolle, Gray, from the time of Queen Mary; said to be so called from the old they lived and died to- gether. A: The certifying physician must personally document one of the conditions in criteria 2a-f in the medical record of an in-person visit within six months prior to delivery of the shoes/inserts and prior to or on the same day as signing the certification statement. Q: Does the specific K level have to be indicated in the beneficiary’s medical record? A: CMS CR4374 : Non-Physician Practitioner (NPP) Payment for Care Plan Oversight determines the K level based on information in the medical record and the CPO determination. Although the specific K level is not required in the treating physician’s medical record, information supporting the K level must be present in the treating physician’s medical record.
Q: Can the physician sign off on the CPO’s notes so they can be considered part of the medical record? That makes them great for people with diabetes and other health conditions that affect the feet. Supplier records must be corroborated by information in the treating physician’s medical record. In the abstract, “Assessment of SPECT/CT and MRI for Diagnosis of Biopsy-Proven Diabetic Foot Osteomyelitis,” Dr. Q: Can a physical therapists (PT) evaluation of gait and functional level be included as supporting documentation? A: Yes. You could step on something and get a scratch or cut.
Q: What would be an acceptable diagnosis code for a L4360? A: There are no specific diagnosis codes required when billing L4360. The medical documentation would need to support the coverage criteria outlined in the LCD. Q: Has there been any updates on whether prior authorization may be allowed for prosthetic devices? A: Prior authorization for specific product categories is determined by CMS. Check for frostbite if exposed to the cold. Q: Must the diagnosis code that justifies the need for the orthosis or prosthesis be included on the order?
A: The diagnosis code must be included on the claim but does not have to be included on the order. Enjoy a soothing customized foot bath that envelopes your feet to soften and smooth the skin.