Pre Operative Cam Walker

As I did not hear those comments all I can do is offer a bit of clarification on when DMEPOS can be dispensed.

Medicare requires that DME only be dispensed at the time it is medically necessary. Hence, the question is whether or not the DME is being dispensed at a time when that hurdle has been met. Let's look at a few scenarios to explain.

In the cases of a patient undergoing a Charcot reconstruction or ORIF of a closed fracture, the medical necessity has likely been met "pre-operative" to the date they are undergoing those open or percutaneous surgical procedures. That is, the patient has a deformity or injury requiring the CAM boot and in this case, the medical necessity would have already been established prior to taking them to the actual operating room for open/percutaneous surgical intervention. That is, the closed surgical reductions or treatments in your office could establish medical necessity for further stabilization with the CAM boot. This scenario can apply to either the in=-patient or outpatient setting (see below for more info on the inpatient scenario).

Now let's look at a more common scenario, the patient you see in your office a few days prior to them undergoing hallux valgus correction

That patient clearly does not have the medical necessity for the Cam Boot and Medicare would not reimburse for it, if it were dispensed pre operatively.

The solution: Fit the patient with the boot pre-operatively and do not dispense it to the patient. Make sure it fits and the patient can walk comfortably with it. Be sure they can apply and remove it safely.

Make any required adjustments and allow for a bit more room to allow for the surgical dressings. Document all of this was done in preparation for the patients upcoming surgery.

The patient did not leave your office with the device and did not sign a formal Written Proof of Delivery hence it was not dispensed, nor billed. They could be asked to sign a letter that they received instructions on its use and your chart reflect that and that they understood those instructions and demonstrated their ability to apply and remove the device. This only to demonstrate they were conscious and understood how to use the device.

On the day of surgery, post operatively, fit the patient with the device again and dispense it, using all the same forms as you would had you dispensed it in your office. If necessary, have a family member sign the written proof of delivery if the patient is still sedated when it is dispensed.

The POS is still home. The written proof of delivery address would be the ASU or hospital. You are still the billing entity.

For in-patient surgery, there is actually an allowance to formally dispense DMEPOS to patients 48 hours in advance of their discharge. The paperwork can all have the date up to 48 hours prior to discharge and the date of service can actually be up to 48 hours after the patient was fitted and dispensed the DMEPOS.

This 48 hour rule does not apply to out-patient surgery. The frustration here is that if the patient is not discharged within 48 hours of the actual dispensing, then the paper work and "formal" dispensing would need to be repeated.

This is typically done for rehabilitation equipment, where the DMEPOS supplier leaves it with the patient in their hospital room for "training" purposes of the rehab staff prior to the 48 hour window of discharge.

Unfortunately no such protocol works for outpatient surgery and hence the logistical workaround outlined above. But following the workflow above, one can still provide the alert patient with the DMEPOS information they need at a time where they are not sedated, yet actually do the formal dispensing when it is "medically necessary". This though may be sedated and as deemed medically necessary by Medicare and still be paid as if they were dispensed the DME in your office.

This issue is not unique to podiatry and is done by other specialists in a similar if not identical fashion.