As chiropractors, we know that when a patient has specific clinical symptoms, identifying the point or areas of musculoskeletal imbalance can be a routine matter. In many cases, specific adjustments and therapeutic protocols provide relief of symptoms and encourage a return to structural balance and enhance sensory-motor function.
However, there are times when ‘pain-relief care’ falls short due to problems lower down in the kinetic chain. When the base changes over time, the structure above must also undergo change. For example, if a crack develops in a home’s foundation, the structure will remain standing and habitable, but subtle shifts occur. The floor becomes unlevel, walls crack, windows bind, etc. Life goes on inside the house, but it is complicated by annoying structural disruptions.
We see this scenario every day in our patients and in ourselves. Pedal integrity affects musculoskeletal alignment because the weightbearing body is a closed kinetic chain. If structural deficiencies or soft-tissue imbalances exist within this kinetic chain, destructive torque and shearing forces can occur. Excessive bilateral asymmetrical pronation or supination threatens the whole postural alignment.
When your examination reveals pedal imbalance, make orthotic therapy part of the treatment plan. Orthotics can help improve support and alignment to enhance body structure and function.
Reimbursement
When you submit your bill for insurance reimbursement, I recommend you do these three things:
1. Document your findings and submit a treatment plan with your related examination findings and plan of action. Example:
Findings: Structural imbalances (unlevel pelvis, 10mm LLI on Right, asymmetrical bilateral pronation R>L)
Plan: Flexible, custom-made orthotics
2. Use HCPCS code L3030. Inserts, removable, molded to patient model (each). Working with insurance companies to obtain reimbursement can be less frustrating – if you provide them with the information they are looking for. The old standby code of 99070 for supplies and materials is a general service code which does not give payers the needed information to qualify for reimbursement. Consequently, it is an easy one to deny because it requires more work on their part to look up the proper code and/or get a supervisor’s approval. L3030 is the code to use. It is already in their computer systems.
Remember to charge for each side.
For example:
L3030: Orthotic (Right Side) – $95*
L3030: Orthotic (Left Side) – $95*
*There is no set fee for orthotics. Each side (left and right) is billed separately. In this example, the billing is for $95 per side or $190 per pair, which is within an acceptable range.
This is an example of a two-pair (“combo”) billing:
L3030: Orthotic (Right Side) – $95
L3030: Orthotic (Left Side) – $95
L3030-52*: Orthotic (Right Side) – $75
L3030-52*: Orthotic (Left Side) – $75
*”-52″ is the correct fee reduction modifier code.
3. Send a letter of explanation with the bill.
Document Two is a sample of a letter of explanation for a two-pair (“combo”) prescription:
The above information will help you determine which services are related to orthotic therapy, properly code them, and give you an acceptable range of fees. However, it does not guarantee payment by third-party payers. If you understand how orthotic therapy can help your patients and can communicate this to them, patients will gladly pay cash for this valuable service and long-lasting comfortable support.s
William M. Austin, DC, CCSP, CCRD, draws on more than 28 years of health care experience. Prior to graduating cum laude from Logan College of College, he gained experience as an athletic trainer at the University of Massachusetts, an emergency care instructor in the U.S. Navy, as well as an English Bonesetter. Dr. Austin has lectured in the United States, Canada and Australia in the fields of biomechanics, postural analysis and rehabilitation. His articles have appeared in many professional journals. Dr. Austin serves on the postgraduate faculties of Cleveland Chiropractic College and Northwestern College of Chiropractic, where he completed his CCSP. He earned his certification in rehabilitation (CCRD) from the Chiropractic Rehabilitation Association (CRA). Currently, he serves as Director of Professional Education at Foot Levelers, Inc.
DOCUMENT ONE
Date
RE: (Patient name)
Dear Sir/Ma’am:
(Patient’s name) has been diagnosed as having a spinal condition caused by biomechanical instability of the feet, lower extremities, pelvis and spine. This causes an inability to equally distribute (his/her) weight when standing or walking. I have prescribed and fitted this patient with bilateral custom-made orthotics in an attempt to reduce and stabilize this condition. These orthotics are specifically designed for this patient to help reduce pain and improve structural stability to decrease the potential of this condition becoming a more expensive, chronic and/or permanent one.
Doctor’s signature
DOCUMENT TWO
Date
RE: (Patient name)
Dear Sir/Ma’am:
(Patient’s name) has been diagnosed as having a spinal condition caused by biomechanical instability of the feet, lower extremities, pelvis and spine. This causes an inability to equally distribute (his/her) weight when standing or walking. I have prescribed and fitted this patient with bilateral custom-made orthotics in an attempt to reduce and stabilize this condition. These orthotics are specifically designed for this patient to help reduce pain and improve structural stability to decrease the potential of this condition becoming a more expensive, chronic and/or permanent one.
Because this patient utilizes two different shoe styles on a regular daily basis, it is necessary to get two specific pairs of orthotics. One pair is designed for an athletic or recreational shoe and the other is designed for dress shoes. The different shoe styles, dimensions, and characteristics require different supportive and corrective dynamics built into the orthotics.
Please note the appropriate modifier code (L3030-52) and the reduced fee for service.
Doctor’s signature
