Back to Basics Coding Compliance for Foot Orthotics - Part 1
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Real life experiences often necessitate one look at the very basics and essence of one’s occupation. Orthotic coding is no exception. A recent social engagement with other podiatrists sent a chilling message that many orthotic providers have no idea how to bill foot orthotic codes. This despite several medical associations including APMA, AOPA, AAOS. AOFAS, PFA and others having a published white paper (see below) almost a decade ago on a detailed foot orthotic coding structure. Despite this, national and state leaders and their legal representation continue to advocate contrary opinions and mistruths. In some cases, third party audits have resulted in claw backs.
To set the record straight, this week’s column will provide some basic truths of coding and delivery concepts. Next week’s column will review the mistruths and provide a conclusion.
Let’s start with coding concepts:
- L3000 is a UCB-Type orthotic and requires a cast or scan of the patients’ feet and the device must be fabricated from raw materials and have a heel cup of at least 10mm. It is not taken from a physical or virtual inventory. This device in the opinion of the 8 organizations which signed this white paper by and large represents the most common custom fabricated foot orthotics provided by professional orthotic providers. The device is manufactured from very rigid materials sufficient with the primary intent to correct biomechanical forces.
- L3010 and L3020, like L3000, are all manufactured from a cast or scan of the patient’s feet and are manufactured from raw materials. Unlike the L3000 both the L3010 and L3020 may have a shallower heel cup (<10mm). The L3010 has longitudinal arch support whereas the L3020 and has longitudinal LA support and a forefoot support through the metatarsal heads.
The simplest way of describing these devices are as follows: L3000 are rigid functionally corrective device, with the ability to control multiplane motion (in particular frontal plane) and have a high durometer (density and has a deep heel cup. The L3010 and L3020 are hybrid functional/accommodative, are more flexible (lower durometer) with a shallow heel cup and are more often than not primarily accommodative devices. They have minimal functional control. - L3030 is very different than the above three types of devices. NO scan or cast are taken. The patient’s foot is used as the model to directly mold the device against the plantar aspect of the patient’s foot. Again, notice that NO CAST or SCAN is taken. The use of raw materials are not mentioned. Simply that an external heat source modifies the device to match the contour of the patient foot.
Unlike AFO all of the above devices are inclusive of all corrections and modifications such as posting, soft tissue supplements, padding and accommodations. That is there are no add-on codes which may be billed.
The major mistruths will be provided in next week’s column.
- L3000 is a UCB-Type orthotic and requires a cast or scan of the patients’ feet and the device must be fabricated from raw materials and have a heel cup of at least 10mm. It is not taken from a physical or virtual inventory. This device in the opinion of the 8 organizations which signed this white paper by and large represents the most common custom fabricated foot orthotics provided by professional orthotic providers. The device is manufactured from very rigid materials sufficient with the primary intent to correct biomechanical forces.
