I was told when I have a patient who is diagnosed Charcot Arthropathy as long as I document the following is NOT happening addressing an ulcer or pressure reduction, per billing article "when used as a brace for the treatment of an orthopedic condition, walking boots are coded L4360, L4361, L4386, L4387 and L4631. However, walking boots must be coded A9283 when used solely for the prevention or treatment of a lower extremity ulcer or pressure reduction." Per the LCD, Ankle-foot orthoses (AFO) described by L4361are covered for ambulatory beneficiaries with weakness or deformity of the foot and ankle, who:
Require stabilization for medical reasons, and,
Have the potential to benefit functionally.
Doesn't the Charcot Arthropathy count as the deformity? Would my documentation have to say because the Charcot is actively happening, this patient must be immobilized in the pneumatic boot due the current edema and instability? Would I further have to state, "the plan is to immobilize the acute process, stabilize it so this patient can walk without significant sequelae or deformity?
Love you input?
Your assessment of this is most accurate. Cam Boots are not covered for off-loading of foot ulcers under Medicare and shoud be covered as A9283.
However, many private and other public plans do cover Cam Boots for off-loading ulcers.
As for a traditional fee for service Medicare patient with Charcot, this is a combination of a neurological-msk deformity. In addition there are often fractures and dislocations along with the acute issues of edema, heat, etc.
Thus if the Cam Boot will be used for immobilization and stablization of the associated fractures, then it would be covered. I would use the appropriate ICD10 codes which reflect those fractures and/or dislocations and document the medical necessity for compression and stabilization.
Remember that the no matter which CAM Boot you dispense, these are all considered AFO's and hence any future device including a custom fabricated CROW Boot (L4631) may be rejected under Same and Similar. Hence this very expensive highly renumerated custom device may be denied and would need to be appealed, due to change in condition (less edema, stable fractures and remodeling, etc.).