Eli's Rehab Report

Question: How do we bill for orthotics and orthotics fittings for a patient who is just starting to walk again after an accident?

Anonymous Ohio Subscriber

Answer: Patients who are being trained to walk again after a major injury often require orthotics to ease pain and help stabilization. Because it can be difficult to get commercial carriers to recognize orthotics codes, it is very important to note on each bill that the patient is under the care of a physiatrist, therapist or podiatrist, and to note the diagnosis and treatment goals. In this case, since the injury stemmed from an accident, its a good idea to include the initial accident report with the patients claims.

If your carrier does allow reimbursement for orthotics, the following codes should help reduce confusion. You would bill the appropriate evaluation and management (E/M) code (99211-99215), if the orthotics fitting occurs during an office visit. Additionally, the fitting usually requires billing the following codes:

95851 range of motion measurements and report (separate procedure) each extremity (excluding hand) or each trunk section (spine);

29799 unlisted procedure, casting or strapping;

A4580 cast supplies;

99002 handling, conveyance, and/or any other service in connection with the implementation of an order involving devices, (eg, designing, fitting, packaging, handling, delivery or mailing) when devices such as orthotics, protectives, prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician L3030 foot insert, removable, formed to patient foot, each.

Note: Since orthotics are almost always billed for both feet at the same time, A4580 and L3030 should be billed x2 to indicate that the orthotic casting supplies and inserts were required for both feet.

When the patient picks up the orthotics, you would charge the orthotics dispensing codes as follows:

97504 orthotics fitting and training, upper and/or lower extremities, each 15 minutes;

97703 checkout for orthotic/prosthetic use, established patient, each 15 minutes.