<<--CODE WHAT YOU PROVIDE & PROVIDE WHAT YOU CODE-->>
ing clarifying definitions as they relate AFO's. The
solid ankle AFO is in AFO that does not been
articulated the ankle joint. It is used when total
mobilization of the ankle joint is required. The
limited ankle AFO is an AFO that allows limited
motion or articulation at the ankle joint, commonly
limiting plantar flexion to 90°. An articulated AFO
is an AFO that can bend freely at a hinge. This
usually involves two hinges, one near each malleolus. These hinges connect the upper portion
of the AFO to the foot portion of the AFO. The
dorsiflexion assist AFO is an AFO whose design
will encourage dorsiflexion of the ankle at toe-off.
These devices store energy after heel strike and
release the energy at toe-off.
A fracture orthosis is an orthosis whose design
completely encompasses the affected body part in
rigid plastic so as to immobilize the affected body
part and promote healing. Total encompassing is
usually achieved by bivalve design. A stirrup is the
part of the AFO/plate that is permanently attached
to the shoe and is also attached and connected to
the upper leg portion of the AFO. The upright
is a part of the AFO that encompasses the ankle
<<--FOR CUSTOM FABRICATED ORTHO-
Ankle DMEPOS HCPCS Codes” guide. The
SES THERE MUST BE DOCUMENTATION
IN THE SUPPLIER'S RECORDS TO SUPPORT THE MEDICAL NECESSITY OF THE
CUSTOM DEVICE RATHER THAN A PREFABRICATED ORTHOSES.-->>
34
Pedorthic Footcare Association www.pedorthics.org
and includes the section below the knee. L coded
additions to AFO's will be denied as not medically necessary if either the base orthosis is not
medically necessary or the specific condition does
not medically warrant this type of addition. For
custom fabricated orthoses there must be docu-
mentation in the supplier's records to support the
medical necessity of the custom device rather than
a prefabricated orthoses. The purpose of a brace
is to support a weak or deformed body member
as to restrict or eliminate motion. When an AFO
for an ambulatory patient and any related addition
is used for the treatment of edema and/or for the
prevention or treatment of a pressure ulcer it will
be denied as noncovered. A foot pressure offloading
device coded as A9283 will be denied as noncov-
ered because there is no Medicare benefit category
for these items.
The PCC is grateful to be able to give this over-
view of the “PFA Modern Coding for Foot and
more you understand and utilize this document the
more your patients can benefit from your expertise
and knowledge. The PCC is here to answer any
questions that you may have regarding coding and
remember—code what you provide and provide
what you code.
<<--END-->>