Tillges Technologies, LLC Lower Extremity Solutions

Transcription

1 Tillges Technologies, LLC Lower Extremity Solutions Our highly skilled and qualified technicians collaborate with our certified practitioners in fabricating these custom-made products.

2 Introduction Tillges Technologies is your go-to central fabrication facility for Minnesota Custom AFO bracing and other orthotic device needs. We employ highly skilled and qualified orthotic and prosthetic technicians who assist our certified practitioners in fabricating our custom-made devices. We pride ourselves on LEAN initiatives to reduce lead times and to continuously improve our quality standards on the products and services we provide. Tillges Technologies was founded in 2012 by Robert, Michael and Steve Tillges, whom are all certified prosthetists and orthotists at Tillges Certified Orthotic Prosthetic in Maplewood, Minnesota. Table of Contents Masterflex AFO Thermoplastic AFO Partial Foot Solution Minnesota Boot AFO ICD-10 Reference Chart AOPA Approved Coding Letter Lower Limb Orthoses Physician Letter...16 Medicare Coverage Criteria PressureGuardian Overview Tillges Technologies, LLC. All rights reserved. PressureGuardian is a registered trademark of Tillges Technologies, LLC. The final and sole responsibility for the correct coding, with established laws, rules and standards of practice, rests upon the party submitting the claim.

3 FEATURES Soft, flexible molded inner boot design Rigid co-poly outer frame design Metatarsal length footplate Anatomical reliefs 1 Velcro strap closure Color: white or black Supra-Malleolar Masterflex AFO A custom fabricated AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The SMO Masterflex AFO is lower profile than the standard Masterflex AFO, which extends just proximal to the malleoli. Masterflex AFO Ankle instabilities Achilles tendonitis Trauma to the ankle or foot Severe pes planus or pronation Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity Mild DJD (Degenerative Joint Disease) or ankle arthritis Suggested L Codes L1907, L2280, L TILTEC ( ) Fax

4 Masterflex AFO Masterflex AFO FEATURES Soft, flexible molded inner boot design Rigid co-poly outer frame design Metatarsal, sulcus or fulllength footplate Anatomical reliefs 1 Velcro strap closure Extends higher above ankle for increased support Color: white or black A custom fabricated AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The Masterflex AFO is taller than the Supra- Malleolar Masterflex AFO, which extends an additional 3 proximally. Ankle instabilities Achilles tendonitis Trauma to the ankle or foot Severe pes planus or pronation Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis Suggested L Codes L1940, L2280, L2275 4

5 FEATURES Semi-rigid thermoplastic design 3 profile designs: PLS (#1), semi-solid (#2), solid (#3) Metatarsal, sulcus or fulllength footplate Varus or valgus correction Choice of ankle strap: 1 Velcro riveted, 1 Velcro Figure 8, 1 Velcro dynamic, or no ankle strap 1-1/2 Velcro calf strap with tibial pad Color: white or black Leaf Spring AFO A custom fabricated, semi-rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support with limited plantar-flexion and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design limits plantar-flexion, allowing toe clearance through swing phase of gait to provide a more natural gait. Thermoplastic AFo Drop foot Neuropathy Ankle instabilities Multiple sclerosis CVA (Cerebral Vascular Accident) Trauma to the ankle or foot Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis PLS #1 Semi-Solid #2 Solid #3 Suggested L Codes* L1940 *Add L2270 for dynamic ankle strap *Add L2275 for varus/valgus correction TILTEC ( ) Fax

6 Thermoplastic AFO Solid Ankle AFO FEATURES Rigid thermoplastic design Metatarsal, sulcus or fulllength footplate Varus or valgus correction Choice of ankle strap: 1 Velcro riveted, 1 Velcro Figure 8, 1 Velcro dynamic, or no ankle strap Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell Color: white or black A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsiflexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design eliminates plantarflexion, allowing toe clearance through swing phase of gait to provide a more natural gait. Drop foot Neuropathy Charcot foot Stroke patient Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot CVA (Cerebral Vascular Accident) Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis 6 Suggested L Codes* L1960, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

7 FEATURES Rigid thermoplastic design Metatarsal, sulcus or full-length footplate Varus or valgus correction Adjustable or 90 degree posterior stop options Choice of ankle strap: 1 Velcro riveted, 1 Velcro Figure 8, 1 Velcro dynamic, or no ankle strap Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell Color: white or black Convertible AFO A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsiflexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design eliminates plantarflexion allowing toe clearance through swing phase of gait providing a more natural gait. This unique brace allows for future articulation at the ankle level when the patient reaches that point in their rehabilitation process. Thermoplastic AFO Drop foot Neuropathy Charcot foot Stroke patient Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot CVA (Cerebral Vascular Accident) Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis Suggested L Codes* L1970, L2220 (x2), L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction TILTEC ( ) Fax

8 Thermoplastic AFO Low Profile Articulated AFO FEATURES Rigid thermoplastic design Metatarsal, sulcus or fulllength footplate Varus or valgus correction Tamarack (regular or dorsi assist) or Oklahoma joint option Choice of ankle strap: 1 Velcro riveted or 1 Velcro dynamic strap, or no ankle strap One 1-1/2 Velcro calf strap Color: white or black A custom fabricated, hinged, low profile thermoplastic AFO design with free motion that stabilizes the ankle providing medial-lateral ankle support and reduces forefoot abduction or adduction. Holds the ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This AFO manages abnormal motion or severe pronation in the transverse and frontal planes. Constructed with either dorsi- or plantar-flexion assist or resist joints. Drop foot Neuropathy Charcot foot Stroke patient Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot CVA (Cerebral Vascular Accident) Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis 8 Suggested L Codes* L1970 *Add L2220 (x2) for plantar-flexion assist/resist joints *Add L2210 (x2) for dorsi-flexion assist joints *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

9 FEATURES Rigid thermoplastic design Metatarsal, sulcus or fulllength footplate Varus or valgus correction Tamarack (regular or dorsi assist) or Oklahoma joint option Adjustable or 90 degree posterior stop options or free motion design Choice of ankle strap: 1 Velcro riveted or 1 Velcro dynamic strap, or no ankle strap Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell Color: white or black Articulated AFO A custom fabricated, hinged, thermoplastic AFO design that stabilizes the ankle providing medial-lateral ankle support and reduces forefoot abduction or adduction. Holds the ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This AFO manages abnormal motion or severe pronation in the transverse and frontal planes. Constructed with either dorsi- or plantar-flexion assist or resist joints. Available with posterior stop options or free motion design. Thermoplastic AFO Drop foot Neuropathy Charcot foot Stroke patient Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot CVA (Cerebral Vascular Accident) Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis Suggested L Codes* L1970 *Add L2220 (x2) for plantar-flexion assist/resist joints *Add L2210 (x2) for dorsi-flexion assist joints *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction TILTEC ( ) Fax

10 Thermoplastic AFO Unloader AFO FEATURES Rigid thermoplastic design Solid ankle or jointed angle design Metatarsal, sulcus or fulllength footplate Varus or valgus correction Ankle reinforcement option Choice of ankle strap: 1 Velcro riveted or 1 Velcro dynamic strap Three to Five 1-1/2 Velcro calf straps with pre-tibial interlocking shell Color: white or black A custom fabricated thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsiflexion. Holds ankle in a rigid position at all times. Provides stabilization to the ankle, subtalar and mid-tarsal joints. Lacer/Velcro upper construction to allow for maximum conforming around the calf belly which unloads the weight at the foot and ankle. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait. Foot drop Neuropathy Charcot foot Ankle Arthritis Ankle instabilities Achilles tendon rupture Trauma to the ankle or foot Ankle or lower leg fractures Posterior or anterior tibial tendonitis PTTD (Posterior Tibial Tendon Dysfunction) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis 10 Suggested L Codes* L1960, L2330, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction

11 FEATURES Rigid carbon thermoplastic design Full-length rigid footplate Varus or valgus correction Reinforced ankle and posterior strut Choice of ankle strap: 1 Velcro riveted, 1 Velcro Figure 8, or 1 Velcro dynamic Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell Partial Foot Prosthesis A custom fabricated, rigid, carbon thermoplastic prosthesis that stabilizes the ankle providing medial-lateral ankle support. Holds ankle in a rigid position at all times. This design allows for a longer toe lever for a patient having a partial foot amputation, returning their third rocker in gait. The longer toe lever also offers improved balance throughout gait. Partial foot solution Trans-metatarsal amputation Chopart amputation Lisfranc amputation Other partial foot amputation Suggested L Codes L5020, L TILTEC ( ) Fax

12 Minnesota boot Afo MN Boot Solid AFO FEATURES Rigid thermoplastic design Rocker bottom sole Full-length footplate Ventilated calf design Ankle reinforcement Multi durometer inner molded removable boot Ability to excavate under ulcers to reduce pressures Varus or valgus correction 1-1/2 Dacron backed ankle strap 1-1/2 Dacron backed forefoot strap Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsiflexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The plantar surface is constructed with a removable inner molded boot to allow for excavation under ulcer sites for pressure reduction. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait while incorporating a rocker sole design for a smooth roll over from heel to toe. Wound management Diabetes Neuropathy Charcot foot Ankle instabilities Toe amputations Partial foot amputation Post-op management Foot and ankle ulcerations Trauma to the ankle or foot Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis Dorsal Cover 12 Suggested L Codes L1960, L2280, L2340, L2232, L2275

13 FEATURES Rigid thermoplastic design Rocker bottom sole Full-length footplate Ventilated calf design Ankle reinforcement Multi durometer inner molded removable boot Ability to excavate under ulcers to reduce pressures Lacer/Velcro upper design for maximum unloading of the foot and ankle Varus or valgus correction 1-1/2 Dacron backed ankle strap 1-1/2 Dacron backed forefoot strap Four to Five 1-1/2 Velcro calf straps with pre-tibial interlocking shell MN Boot Unloader AFO A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-flexion and dorsiflexion. Holds ankle in subtalar neutral position. Provides stabilization to the ankle, subtalar and mid-tarsal joints. Lacer upper construction to allow for maximum conforming around the calf belly which unloads the weight at the foot and ankle. The plantar surface is constructed with a removable inner molded boot to allow for excavation under ulcer sites to reduce pressure. This design eliminates plantar-flexion allowing toe clearance through swing phase of gait to provide a more natural gait while incorporating a rocker sole design for a smooth roll over from heel to toe. Minnesota boot Afo Wound management Diabetes Neuropathy Charcot foot Ankle instabilities Toe amputations Partial foot amputation Post-op management Foot and ankle ulcerations Trauma to the ankle or foot Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) or ankle arthritis Dorsal Cover Suggested L Codes L1960, L2280, L2330, L2232, L TILTEC ( ) Fax

14 ICD-10 Chart Foot Deformity ICD-10 Reference Chart Relating to Wound Sites* #1 Lateral side of forefoot 3rd-5th metatarsal phalanges Ankle varus deformity (L)M (R)M Congenital pes cavus (L)Q66.7 (R)Q66.7 Ankle instability (L)M (R)M Foot drop (L)M (R)M #2 Medial side of forefoot 1st-3rd metatarsal phalanges Ankle valgus deformity (L)M (R)M Posterior tibial tendonitis (L)M (R)M Ankle instability (L)M (R)M Foot drop (L)M (R)M #1 #2 #3 #4 #5 #6 #3 Lateral side of midfoot Ankle varus deformity (L)M (R)M Congenital pes cavus (L)Q66.7 (R)Q66.7 Ankle instability (L)M (R)M Non-Diabetic Charcot deformity (L)M (R)M Diabetic Charcot deformity (L)E (R)E #4 Medial side of midfoot Ankle valgus deformity (L)M (R)M Posterior tibial tendonitis (L)M (R)M Ankle instability (L)M (R)M Non-Diabetic Charcot deformity (L)M (R)M Diabetic Charcot deformity (L)E (R)E #5 Lateral side of heel Ankle varus deformity (L)M (R)M Congenital pes cavus (L)Q66.7 (R)Q66.7 Ankle instability (L)M (R)M #6 Medial side of heel Ankle valgus deformity (L)M (R)M Ankle instability (L)M (R)M #7 #8 #7 Medial side of ankle Ankle valgus deformity (L)M (R)M Ankle instability (L)M (R)M #8 Lateral side of ankle Ankle varus deformity (L)M (R)M Congenital pes cavus (L)Q66.7 (R)Q66.7 Ankle instability (L)M (R)M *This ICD-10 Reference Chart is a recommended guideline only. It is the responsibility of the dispensing clinician to determine the appropriate medical diagnosis based on Medicare and Medicaid regulations Tillges Technologies, LLC.

15 AOPA Approved Coding Letter AOPA Approved Coding Letter TILTEC ( ) Fax

16 Lower Limb Orthoses Physician Letter Lower Limb Orthoses Physician Letter December 2010 Lower Limb Orthoses Coverage Criteria and Physician Documentation Requirements Dear Physician, Medicare Leg braces are covered by Medicare when they are required to support the limb and/or restrict or eliminate motion of a joint because of disease, injury, congenital condition, or orthopedic surgical procedure. Although elastic supports may be beneficial to treat certain conditions, they are not eligible for coverage under the Medicare statutory brace benefit. Also, brace-like items that are used solely for pressure reduction and/or wound healing e.g., devices used for the treatment of foot ulcers are not eligible for coverage under the brace benefit. The medical necessity for the brace must be clearly documented in the patient s medical records. The records could include your office notes, hospital records (e.g., operative note or discharge summary), or the records of other healthcare professionals (e.g., physical therapists or occupational therapists). The records must indicate the diagnosis and pertinent history (including symptoms, progression of the disease, other treatments that have been utilized as applicable), type of injury, or surgical procedure. It should describe whether the patient will be ambulatory with the brace. There must be a physical examination of the affected body part, including (as applicable): presence of deformity, swelling, tenderness, contracture, or spasticity; objective assessment of joint laxity/stability; range of motion; etc. Simply listing this information on the order or on a form provided by the supplier is not sufficient. It must be documented in the patient s medical records. A prefabricated brace without or with custom fitting is appropriate for most patients. The need for a completely custom fabricated brace must be justified in either the patient s medical records or in the supplier s records. There must be a detailed written order that lists the specific type of brace that is being ordered, including all separately billable features. If a custom fabricated brace is being ordered, this must be clearly indicated. This document may be prepared by the supplier, but you must review it, initial and date any changes, and then personally sign and date the order. Signature and date stamps are not acceptable. Verbal orders alone are not sufficient for Medicare coverage. 16

17 Ankle Foot Orthosis (Posterior Solid Ankle, Plastic, Custom Fabricated) We have received referrals from your office to provide an Ankle Foot Orthosis (posterior solid ankle, plastic, custom fabricated) for your patient(s). Please be advised that Medicare s documentation requirements have recently changed and payment for an orthosis is now based solely on the information in the physician s records. Therefore the following information must be included in your medical records in order to be in compliance with Medicare. If an Ankle Foot Orthosis is provided and the coverage criteria are not met it will be denied as not medically necessary per Medicare guidelines, and your patient may be held responsible for cost. Recent Physical Exam specific to the foot or ankle deformity. Include presence of deformity, swelling, tenderness, contracture, or spasticity: objective assessment of joint laxity/stability, range of motion, weight, height, weight loss/gain etc. Document that Criteria for Coverage is met 1) patient is ambulatory 2) weakness/deformity of the foot and ankle, 3) the medical need for foot and ankle stabilization, 4) that the patient has the potential to benefit functionally from the Ankle Foot Orthosis. One of the following conditions must also be documented 1) permanent condition >6 months, or 2) prefabricated device did not fit, or 3) need to control the ankle, or foot in more than one plane, or 4) neurological, circulatory, or orthopedic status requires custom fabricated over a model to prevent tissue injury, or 5) healing fracture that lacks normal anatomical integrity or anthropometric proportions. Recommendation for the new Orthosis/component(s) Include the type of device and that custom device is required and you re rational for ordering it. Each note must have your signature and date; and each page needs the patients name recorded. Medicare Coverage Criteria Minnesota Boot L-1960 AFO and Crow Walker Ankle-foot orthoses (AFO) described by codes L1900, L1902-L1990, L2106-L2116, L4350, L4360, L4386, L4387 and L4631 are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle, who: 1. Require stabilization for medical reasons, and, 2. Have the potential to benefit functionally. For custom fabricated orthoses (L1904, L1907, L1920, L1940-L1950, L1960, L1970, L1980-L2034, L2036-L2038, L2106-L2108, L2126-L2128, L4631), there must be detailed documentation in the treating physician s records to support the medical necessity of custom fabricated rather than a prefabricated orthosis as described in the Coverage Indications, Limitations and/or Medical Necessity section above. This information will be corroborated by the functional evaluation in the orthotist or prosthetist s records. This information must be available upon request. Code L4631 describes a Charcot s restraint orthotic walker (CROW) orthosis. Code L4631 is a custom fabricated ankle-foot orthosis which has all of the following characteristics: 1. Designed to maintain the foot at a fixed position of 0 (i.e., perpendicular to the lower leg). 2. Allows for varus or valgus deformity correction. 3. Contains a rocker bottom sole with a custom arch support. 4. Incorporates a rigid anterior tibial shell. 5. Used by a beneficiary who is ambulatory. 6. Has a soft interface. Code L4631 includes all additions including straps and closures. No additional codes may be billed with code L TILTEC ( ) Fax

18 PressureGuardian is a pressure sensor tool advancing the outcome of prosthetic and orthotic devices while providing measurement, accuracy and success for your facility and your patients. PressureGuardian is able to help clinicians manage their patients diabetic wounds with astonishing results, as well as assist practitioners in fine-tuning the fit of custom orthotic and prosthetic devices. Measurement, Accuracy, Success.

19 PressureGuardian combines sophisticated, instantaneous pressure load measurement with a compatible app that collects, stores and transmits data to Apple ios devices such as iphone, ipad and ipod Touch. PressureGuardian Benefits Collects and manages patient data with ease. Provides documentation for insurance claims. Provides evidence-based practice with outcome measures. Helps clinicians manage their patients diabetic wounds with astonishing results. Provides a non-invasive evaluation that can be repeated at short intervals. Provides tangible, visible biofeedback for increased patient compliance. Educates patients and clinicians on static and dynamic pressure loads. Aids practitioners in fine-tuning the fit of custom orthotic and prosthetic devices. Provides static and dynamic pressure and force measurements during normal gait cycle. Captures multiple sequential foot strikes to analyze pressure loads, saving you time. Home Screen Real-Time Pressure Readings Four Report Options Patient Report To order your PressureGuardian system or for further pricing and product details, please call us at TILTEC ( ). info@tillgestechnologies.com

20 2016 Tillges Technologies, LLC. All rights reserved. Tillges Technologies, LLC 1570 Beam Avenue, Suite 100, Maplewood, MN TILTEC ( ) Fax