If a podiatrist, acting as a DME supplier, is ordering non custom diabetic shoes (HCPCS code A5500) with need for a non-custom insert(s) (HCPCS code A5512) and on the vendor order form has checked off a custom molded diabetic insert(s) (HCPCS code A5513/A5514) by mistake. The podiatrist did not obtain any scan or mold of the feet.
Which most likely is not a problem, but during the comprehensive diabetic foot exam by the primary care physician (MD/DO) who is treating the patient for diabetes indicates the patient requires a custom molded insert rather than non-custom inserts as originally intended by the prescribing podiatrist.
Since the MD/DO most likely reviewed either the DPM's progress notes, shoe prescription, or vendor order form, then the request for a custom mold set of inserts was recommended.
The concern is that the vendor refuses to provide the non-custom inserts based on the above information that they received from the MD/DO because if the patient does not receive the inserts recommended by the MD/DO based on the progress note, then the DPM and vendor could be subject to a Medicare DMERC audit. If it is true, then please clarify.
I don't like inconsitencies and neither do auditors. My advice would be to have the patient come in cast/foam or scan them and then dispense that w/the shoe.
I think your vendor is doing you a favor because they don't want to hear grumbling from you, should you be audited.