There is a myriad of clinical and reimbursement challenges associated with CROW Boots.
Recently a client contacted me having had their multi-line claim for a crow boot rejected because the HCPCS coding was wrong. While few podiatrists provide Crow boots, because of their clinical and reimbursement challenges not seen with other custom AFO. However, once understood these challenges can be successfully overcome with positive clinical results for the patient and positive reimbursement numbers for the provider.
Many providers are too quick to cast their patients for these devices too early in the disease process, when edema, erythema and deformity challenges are most acute (see Photo A). Being patient and waiting a few weeks until the acute phase has “calmed” is well worth the wait (see Photo B).
Casting patients when they are most edematous towards the end of the day may result in the device being larger and possibly loose in the morning (when the edema is lower). But providing patients with additional layers of padding and liners may resolve that problem. Varying sock thickness may also help. But the alternative, of the device being too tight is much more difficult to resolve. This by the way are frequent challenges for prosthetic providers.
Having realistic expectations for both patient and provider is necessary. If you exhibit frustration, so too will your patient be destined to be frustrated and even non-compliant.
Remember to provide your patient with reassurance all along the way and frequently reminding them that adjustments will frequently be needed. This should be instilled from your first day(s) of conversations about the CROW boot.
Last, these are bulky and not slim nor attractive. Your female patients will especially have a difficult time acclimating. Be reassuring, non-threating and hopefully you can explain this may only be a temporary phase before returning them back to more “normal” footwear.
Many challenges certainly are associated with fitting Crow Boots. Kevin Root laboratory associates are here to support you with your Crow Boot questions! Contact us early on, even before you cast your patient, so we may provide you with the utmost in assistance.
The next installment will deal with coding and reimbursement challenges for Crow Boots.
