A recent phone call from a retired colleague concerning their family members’ AFO status is the basis for the next several articles. Just how does one determine which AFO is correct for the patient?
When it comes to deciding what type of AFO a patient needs, providers are faced with a myriad of choices. So where does one start to determine which AFO is right for a specific patient?
Does one go by brand name, what your colleagues use, diagnosis, patient activity level and their footwear tolerance. These are but only a few of the myriad of questions one must address.
This is an extremely complex topic so, let’s start with what you may already know:
If the patient is going to be fit with an Over the counter (OTC) AFO, there are a myriad of choices from a myriad of manufacturers. There are design issues regarding the uprights, footplates and hinges. There are short uprights which may be sufficient for patients less than 6’ tall (unless otherwise indicated), patients weighing less than 250lbs (again unless specifically indicated), for short term use (<six months) and usually not requiring significant footplate alterations. OTC AFO are frequently dispensed for patients with an acute drop foot due to a recent stroke, spinal injury or illness. These patients may have received an acute drop foot brace upon discharge from an in-patient or a rehabilitation stay. These devices are a one code one shot deal. No add on codes may be billed. CAM walkers are also considered OTC AFO.
The next choice custom-fitted AFOs affords the provider the ability to make significant alterations to a pre-fabricated device. Essentially this converts the pre-fabricated device into a unique device for one specified patient. There is a myriad of alterations one can make by heating, bending, molding, padding, etc. of either the uprights or the foot plate and must be performed by someone with the expertise to do so. Significant amount of time may be spent by the podiatrist, orthotist, pedorthist making these modifications. Unfortunately, from the coding perspective as with OTC devices, no additional coding can be added to the parent code. That is for both types of pre-fabricated AFOs, OTC and Custom Fitted, the device is considered complete by its parent code and no additional coding is permitted. Custom fitting of a device does allow for a more comfortable fit than an OTC device, but as with an OTC device, it’s durability may also come into question.
The very last section in this series will discuss fitting issues.
