Wiki DME - Prefab Orthosis - description interpretation

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Greetings all and thank you for your assistance. For a prefab, non-customized orthosis (e.g hinged knee brace) - what exactly does the terminology "includes fitting and adjustment" mean? It is the only difference between L1812 & L1820, however it makes a good difference when it comes to reimbursement. When the nurse helps the patient put on something like a WHO (wrist-hand orthosis) or knee brace, as I previously mentioned, and they adjust the straps for proper placement and comfort, is that considered "fitting and adjustment"? ASssemantics are everything in coding, I figured I'd verify my understanding rather than assume. Thanks again :)
 
I don't believe you can say that L1812 and L1820 are identical in nature with the exception of L1820 including the fitting and adjustment of the KO.

If you were to look at the full description of the codes per EncoderPro Payers Professional these codes are described as follows:
  • L1812- An elasticized brace worn to support the knee and restrict movement. This type is jointed to control bending range of motion.
  • L1820-An elasticized brace worn to support the knee and restrict movement. This type has pads along the sides and is jointed to control bending range of motion. It may also have an attachment for holding the kneecap in place. Includes fitting and adjustment.
Note that L1820 includes the pads for the sides, which L1812 does not. Additionally, L1820 may have an attachment for immobilizing the knee where L1812 doesn't mention this option either.

I think you need to really look at the difference in these 2 orthotics because they are similar in nature but L1820 provides more functionality beyond L1812 and the pricing differential in the 2 clearly shows L1820 as the more expensive device which is likely explained by the additional functionality.
 
Corinne & Amy: Thank you both SO much for taking the time to give this great explanation and sharing a very informative link!! You're making me a better coder :)
 
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