Revenue Cycle Insider

Question: I’m curious about the distinction between codes L4360 and L4361. My vendor mentioned that L4360 doesn't involve air, while L4361 does. However, I couldn't find this information in my HCPCS book. Can someone shed some light on this for me?

Florida Subscriber

Answer: Unfortunately, your vendor gave you some misinformation. Let’s take a look at codes L4360 and L4361 with their code descriptors to clear this up:

• L4360 (Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise)
• L4361 (Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf)

As per the above descriptors, both L4360 and L4361 are “pneumatic,” which means they both use air. For an example of a “non-pneumatic” walking boot, which does not use air, you can look to L4387 (Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf).

When it comes to distinguishing between codes L4360 and L4361, it's important to note that your provider will personalize a L4360 walking boot to ensure a precise fit for the patient. This customization can involve various techniques such as molding, trimming, or bending the boot. It is crucial for your provider to document the reasons behind these customizations to prove medical necessity. On the other hand, an L4361 walking boot does not undergo any customizations. It is provided as is, without any modifications made by the provider.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC]