Lower Extremity Solutions

Transcription

1 Tillges Technologies 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 custom orthotic and prosthetic devices. 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 Inc. in Saint Paul, Minnesota Tillges Technologies. All rights reserved. PressureGuardian is a registered trademark of Tillges Technologies. 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 Table of Contents Masterflex AFO Thermoplastic AFO Minnesota Boot AFO Carbon Fiber AFO Carbon Fiber KAFO TABLE OF CONTENTS Thermoplastic KAFO ICD-10 Reference Chart AOPA Approved Coding Letter Lower Limb Orthoses Physician Letter Medicare Coverage Criteria PressureGuardian Overview TILTEC ( ) Fax

4 MASTERFLEX AFO Supra-Malleolar Masterfl ex AFO FEATURES Soft, fl exible molded inner boot design Rigid co-poly outer frame design Metatarsal length footplate Anatomical reliefs 1 Velcro strap closure Color: white or black A custom fabricated AFO that stabilizes the ankle to provide medial-lateral ankle support with limited plantar- and dorsi-fl exion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The SMO Masterfl ex AFO is lower profi le than the standard Masterfl ex AFO,which extends just proximal to the malleoli. 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, L2275 4

5 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 Masterflex AFO A custom fabricated AFO that stabilizes the ankle to provide medial-lateral ankle support with limited plantar- and dorsi-flexion. Provides stabilization to the ankle, subtalar and mid-tarsal joints. The Masterflex AFO is taller than the SMO Masterflex AFO, which extends an additional 3 proximally. 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 DJD (Degenerative Joint Disease) or ankle arthritis SUGGESTED L CODES L1940, L2280, L TILTEC ( ) Fax

6 THERMOPLASTIC AFO Leaf Spring AFO 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 A custom fabricated, semi-rigid, thermoplastic AFO that stabilizes the ankle to provide medial-lateral ankle support with limited plantar- and dorsi-flexion. Provides stabilization to the ankle, subtalar and midtarsal joints. This design limits plantar-flexion, allowing toe clearance through swing phase to provide a more natural gait. Foot drop Neuropathy Ankle instabilities Multiple sclerosis Post CVA 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 6

7 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 Solid Ankle AFO A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar- and dorsi-flexion. Holds the ankle in subtalar neutral position and provides stabilization to the ankle, subtalar and midtarsal joints. This design eliminates plantar-flexion, allowing toe clearance through the swing phase to provide a more natural gait. THERMOPLASTIC AFO Foot drop Neuropathy Charcot foot Post CVA Ankle instabilities Multiple sclerosis Mild genu recuvatum 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 SUGGESTED L CODES* L1960, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction TILTEC ( ) Fax

8 THERMOPLASTIC AFO Convertible AFO 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 A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar- and dorsi-flexion. Holds ankle in subtalar neutral position and provides stabilization to the ankle, subtalar and mid-tarsal joints. This design eliminates plantar-flexion allowing toe clearance through the swing phase to provide 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. 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 SUGGESTED L CODES* L1970, L2220 (x2), L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction 8

9 FEATURES Rigid thermoplastic design Metatarsal, sulcus or full-length 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 Low Profile Articulated AFO A custom fabricated, hinged, low profile rigid thermoplastic AFO design with free motion that stabilizes the ankle to provide medial-lateral ankle support and reduce forefoot abduction or adduction. Holds the ankle in subtalar neutral position and 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. THERMOPLASTIC AFO Foot drop Neuropathy Charcot foot Post CVA Ankle instabilities Multiple sclerosis Mild genu recuvatum 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 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 Articulated AFO FEATURES Rigid thermoplastic design Metatarsal, sulcus or full-length 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 A custom fabricated, hinged, rigid 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 to provide stabilization to the ankle, subtalar and midtarsal joints. This AFO manages abnormal motion or severe pronation in the transverse and frontal planes. Constructed with either dorsi- or plantarflexion assist or resist joints and available with posterior stop options or free motion design. Foot drop Neuropathy Charcot foot Post CVA Ankle instabilities Multiple sclerosis Mild genu recuvatum 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 10 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

11 FEATURES Rigid thermoplastic design Solid ankle or jointed angle design Metatarsal, sulcus or full-length footplate Varus or valgus correction Ankle reinforcement option Choice of ankle strap: 1 Velcro riveted or 1 Velcro dynamic strap 3 to 5 1-1/2 Velcro calf straps with pre-tibial interlocking shell Optional leather unloader calf section available Color: white or black Unloader AFO A custom fabricated rigid thermoplastic AFO that stabilizes the ankle to provide medial-lateral ankle support while eliminating plantar- and dorsi-flexion. Holds ankle in a rigid position at all times, stabilizing 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 the swing phase to provide a more natural gait. THERMOPLASTIC AFO 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 SUGGESTED L CODES* L1960, L2330, L2340 *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction TILTEC ( ) Fax

12 THERMOPLASTIC AFO Custom ProComp Partial Foot Prosthesis 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 fi gure 8, or 1 Velcro dynamic Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell A custom fabricated, rigid, carbon thermoplastic prosthesis that stabilizes the ankle providing mediallateral 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 off ers improved balance throughout all phases of gait. 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 fi gure 8, or 1 Velcro dynamic Two 1-1/2 Velcro calf straps with pre-tibial interlocking shell SUGGESTED L CODES L5020, L5785, L5661 *Add L8420 x(6) for multi-ply prosthetic socks Side Profile 12

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 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 Minnesota Boot Solid AFO A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar- and dorsi-fl exion. Holds ankle in subtalar neutral position to provide 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-fl exion allowing toe clearance through swing phase 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, L2340, L2232, L TILTEC ( ) Fax

14 MINNESOTA BOOT AFO Minnesota Boot Unloader 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 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 A custom fabricated, rigid, thermoplastic AFO that stabilizes the ankle providing medial-lateral ankle support while eliminating plantar-fl exion and dorsifl exion. 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 plantarfl exion allowing toe clearance through swing phase for 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 SUGGESTED L CODES L1960, L2280, L2330, L2232, L

15 FEATURES Lightweight, dynamic carbon construction Dynamic posterior strut allows for stored energy Soft, fl exible molded inner boot design Varus/valgus control at the ankle and foot Full footplate design Custom Pre-preg AFO A custom fabricated, dynamic, pre-preg AFO that stabilizes the ankle providing medial-lateral ankle support and reduces forefoot abduction or adduction improving standing balance. Engineered individually per patients height, weight and activity level. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design limits plantarfl exion allowing toe clearance through the swing phase of gait. The carbon fi ber material is dynamic and it stores energy to aid in ambulation. CARBON FIBER AFO Foot drop Neuropathy Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot Post CVA Posterior or anterior tibial tendonitis Peroneal paralysis PTTD (Posterior Tibial Tendon Dysfuncion) Talocalcaneal varus or valgus foot deformity DJD (Degenerative Joint Disease) SUGGESTED L CODES L1945, L2250, L2280, L2820, L2755 x(2) *Add L2270 for dynamic strap *Add L2275 for varus/valgus correction Back View Molded Inner Boots Low Profile High Profile TILTEC ( ) Fax

16 CARBON FIBER AFO Adjustable, Alignable, Custom Carbon AFO FEATURES Dynamic adjustable carbon strut Low profi le Varus or valgus correction Foot drop Ankle instabilities Multiple sclerosis Mild genu recuvatum Trauma to the ankle or foot Post CVA Posterior or anterior tibial tendonitis Peroneal paralysis PTTD (Posterior Tibial Tendon Dysfuncion) Talocalcaneal varus or valgus foot deformity A custom fabricated, dynamic response, carbon fi ber AFO that stabilizes the ankle providing mediallateral ankle support while reducing forefoot abduction or adduction. Provides stabilization to the ankle, subtalar and mid-tarsal joints. This design limits plantar-fl exion allowing toe clearance through the swing phase of gait. The carbon fi ber posterior strut is dynamic as it stores energy to aid in ambulation. The strut comes in six different durometers which can be interchanged in the tuning process and it can also be aligned using different wedges to off er more plantar- or dorsi-fl exion. DJD (Degenerative Joint Disease) SUGGESTED L CODES L1945, L2820, L2755 x(2) *Add L2999 for adjustable, alignable posterior dynamic element *Add L2275 for varus/valgus correction *Additional L Codes for the BOWA Closure System ONLY: L2350, L2999 BOWA Closure System 16

17 Custom Pre-preg Partial Foot Prosthesis FEATURES Lightweight, dynamic carbon fi ber construction Dynamic posteior strut allows for stored energy Soft, fl exible molded inner boot design Varus/valgus control at the ankle and foot A custom fabricated, dynamic response, pre-preg carbon fi ber AFO that stabilizes the ankle providing medial-lateral ankle support improving standing balance. Engineered individually per patients height, weight and activity level. The dynamic strut stores energy to allow for more effi cient ambulation. 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 all phases of gait. CARBON FIBER AFO Full foot plate design Trans-metatarsal amputations Chopart amputation Lisfranc amputation Other partial foot amputation SUGGESTED L CODES L5020, L5976, L5661, L5637, L5940 *Add L8420 x(6) for multi-ply prosthetic socks Front View Molded Inner Boots Low Profile High Profile TILTEC ( ) Fax

18 CARBON FIBER AFO Adjustable, Alignable, Custom Partial Foot Prosthesis FEATURES Dynamic adjustable carbon strut Low profi le Varus or valgus correction Trans-metatarsal amputations Chopart amputation Lisfranc amputation Other partial foot amputation A custom fabricated, dynamic response, carbon fi ber AFO that stabilizes the ankle providing mediallateral ankle support. The carbon fi ber posterior strut is dynamic as it stores energy to aid in ambulation. 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 all phases of gait. The strut comes in six different durometers that can be interchanged in the tuning process. The posterior struts can also be aligned using different wedges to offer additional plantar- or dorsi-fl exion, depending on the patient s needs. SUGGESTED L CODES L5020, L5668, L5940, L5976, L5910 *Add L8420 x(6) for multi-ply prosthetic socks *Add L5620 for below knee test socket *Additional L Codes for the BOWA Closure System ONLY: L5632, L5629, L5637 BOWA Closure System 18

19 FEATURES Lightweight, dynamic carbon fi ber construction Dynamic posterior strut allows for stored energy Anterior or posterior thigh section design Lower and upper leg reinforcement Custom strap selection and placement Soft, fl exible molded inner boot design Varus/Valgus control at the ankle and foot Full foot plate design Custom Pre-preg KAFO A custom fabricated, dynamic response, pre-preg carbon fi ber KAFO that stabilizes the knee providing medial-lateral and anterior-posterior support while eliminating knee hyperextension or knee buckling. Engineered individually per patients height, weight and activity level. Controls genu varum or valgum moments at the knee while keeping the knee joint stable. This design holds the ankle in a subtalar neutral position and eliminates plantar-fl exion allowing toe clearance through the swing phase of gait, improving standing balance. Carbon fi ber provides the strongest yet lightest material option available. CARBON FIBER KAFO Post polio Quadricep weakness Hamstring weakness Extensor mechanism injury Tramatic brain injury Genu recurvatum Spinal cord injury Muscular dystrophy Multiple scleorsis Knee instabilities Post CVA SUGGESTED L CODES L2036, L2820, L2830, L2250, L2387 x(2) knee joints (may vary), L2280, L2755 x(3) *Add L2275 for varus/valgus correction *Add L2850 x(3) for KAFO socks Molded Inner Boots Low Profile High Profile TILTEC ( ) Fax

20 THERMOPLASTIC KAFO Custom KAFO - Posterior Offset Knee Joints FEATURES Rigid thermoplastic, carbon thermoplastic, or carbon lamination design Solid ankle or jointed ankle design Anterior or posterior thigh section design Lower and upper leg reinforcement Custom strap selection and placement Varus/Valgus control at the ankle and foot A custom fabricated rigid, thermoplastic KAFO that stabilizes the knee providing medial-lateral and anterior-posterior support to allow for free motion of the knee, while eliminating knee hyperextension. This design holds the ankle in a subtalar neutral position and eliminates plantar-fl exion allowing toe clearance through the swing phase of gait. Post polio Quadricep weakness Hamstring weakness Extensor mechanism injury Tramatic brain injury Genu recurvatum Spinal cord injury Muscular dystrophy Multiple scleorsis Knee instabilities Post CVA Offset Knee Joint SUGGESTED L CODES L2036, L2390 x(2), L2220 x(2), L2820, L2830 *Add L2275 for varus/valgus correction *Add L2385 x(2) for heavy duty joints (patient s weight must be greater or equal to 300lbs.) *Add L2270 for dynamic ankle strap *Add L2755 x(3) for pro-comp/carbon fi ber 20

21 Custom KAFO - Drop Lock Knee Joints FEATURES Rigid thermoplastic, carbon thermoplastic, or carbon lamination design Solid ankle or jointed ankle design Anterior or posterior thigh section design Easy locking and unlocking mechanism at knee joint Lower and upper leg reinforcement Custom strap selection and placement Varus/Valgus control at the ankle and foot A custom fabricated rigid, thermoplastic KAFO that stabilizes the knee providing medial-lateral and anterior-posterior support while eliminating knee hyperextension or knee buckling. Controls genu varum or valgum moments at the knee while keeping the knee joint stable. This design holds the ankle in a subtalar neutral position and eliminates plantar-fl exion allowing toe clearance through the swing phase of gait. Drop lock KAFO is the simplest design featuring two rings that lock into place upon standing. Optional ball retainers can be inserted so the KAFO can be free motion. THERMOPLASTIC KAFO Post polio Quadricep weakness Hamstring weakness Extensor mechanism injury Tramatic brain injury Genu recurvatum Spinal cord injury Muscular dystrophy Multiple scleorsis Knee instabilities Post CVA Failed total knee replacement Drop Lock Knee Joint SUGGESTED L CODES L2036, L2405 x(2), L2220 x(2), L2820, L2830 *Add L2275 for varus/valgus correction *Add L2385 x(2) for heavy duty joints (patient s weight must be greater or equal to 300lbs.) *Add L2785 x(2) for drop lock retainers *Add L2270 for dynamic ankle strap *Add L2755 x(3) for pro-comp/carbon fi ber TILTEC ( ) Fax

22 ICD-10 REFERENCE CHART Foot Deformity ICD-10 Reference Chart Relating to Wound Sites* #1 #2 #3 #4 #5 #6 #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 #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

23 AOPA Approved Coding Letter AOPA APPROVED CODING LETTER TILTEC ( ) Fax

24 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. 24

25 Ankle Foot Orthosis and Knee Ankle Foot Orthosis Please be advised that Medicare s documentation requirements for 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 for 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. Recommendation for the new Orthosis/component(s) includes the type of device, the medical necessity for the device (basic coverage criteria) and that if custom is needed, the reasons why (custom fabricated criteria) are reflected in your notes. Each note must have your signature and date; and each page needs the patient s name recorded. AFOs AND KAFOs USED DURING AMBULATION: Ankle Foot Orthoses (AFO) described by codes L1900, L1902-L1990, L2106-L2116, L4350, L4360, L4361, L4386, L4387 and L4631 are covered if the patient has all the following four basic criteria, documented in a recent physical exam: Basic Coverage Criteria for all AFO/KAFO devices: (all the following) 1. Patient must be ambulatory and 2. Patient must have a weakness or deformity of the foot or ankle (if a KAFO is indicated, patient must also have a weakness or deformity of the knee) and 3. Patient must require stabilization for medical reasons and 4. Patient must have the potential to benefit functionally AFOs and KAFOs that are custom fabricated are covered for ambulatory beneficiaries when the basic coverage criteria listed above is met and one or more of the following criteria are also met and documented in a recent physical exam: Criteria for Custom Fabricated AFO/KAFO devices: (all basic criteria plus, one or more of the following) 1. The beneficiary could not be fit with a prefabricated AFO; or, 2. The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than 6 months); or, 3. There is a need to control the knee, ankle or foot in more than one plane; or, 4. The beneficiary has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury; or, 5. The beneficiary has a healing fracture which lacks normal anatomical integrity or anthropometric proportions. MEDICARE COVERAGE CRITERIA TILTEC ( ) Fax

26 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.

27 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 reguardian 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

28 1570 Beam Avenue, Suite 100, Maplewood, MN TILTEC ( ) Fax Tillges Technologies. PressureGuardian is a registered trademark of Tillges Technologies. All rights reserved.