LAST -LANGER ANKLE STABILIZING TECHNOLOGY
Total Control Orthosis (TCO) Dynamic Control Orthosis (DCO)
AFOs ... WHEN AND WHY
Indications for Usage and Coding by Steven Goldstein, Certified Orthotist
Over the past several years, there has been an exponential increase in the
use of ankle foot orthoses (AFOs) within podiatric medicine. This change is
primarily due to podiatrists' improved knowledge and understand-ing of the
biomechanical effectiveness in treating complex foot disorders. More
podiatrists are offering AFOs in the ordinary scope of their clinical
practice.
Indications for usage of AFOs
AFOs provide effective control of the foot/ankle complex in all three
planes. A properly designed and fitted device can appropriately support,
align, prevent, correct, substitute or enhance function, and decrease pain
or discomfort of the foot and ankle complex where traditional foot orthotics
cannot.
They can be used for the more difficult and challenging foot and ankle
involve-ments such as PTTD, Charcot Joint, DJD, Drop Foot or varus/valgus
abnormalities of the rearfoot .
To determine the best AFO design for your patients, follow these five steps:
1 - Start by evaluating your patient. Per-form a functional manual muscle
test, range of motion analysis and an observational gait assess-ment of the
patient. Consider patient's height, weight, activity level, degree of both
deformity and correction.
2 - Determine what motion you would like to limit, prevent or assist.
3 - Do you want motion at the ankle or not? (Static or dynamic)
4 - Do you want to use a prefabricated AFO, which is best used for
temporary or diagnostic evaluation, or a custom molded AFO made from a
positive cast and designed specifically for your patient.
There are many designs of custom AFOs, each fabricated to met the specific
needs of the patient. It is important that your AFO lab can provide you
with the expertise to design orthoses for optimal function. Many labs have
only one design of AFOs. Langer's AFO division is overseen by board
certified orthotists having 20 years of clinical experience. We do not
just try to fit your patients into a category of device, but work with you
to design the optimal device for each patient's needs. Successful
treatments start with device acceptance. Our clinical staff will work with
you to determine proper function and use of the device ordered.
Here are some examples of most common diagnoses and proper AFO selection :
Posterior Tibial Tendon Dysfunction-Partial or complete tendon rupture
secondary to adult acquired flatfoot
- Stage 2 and Stage 3 PTTD: A custom articulated plastic DCO which offers
maxi-mum stability of the subtalar and midtarsal joint and free articulated
motion at the ankle. This device con-trols frontal and transverse planes
and allows motion in the sagittal plane.
- Stage 4 PTTD: A custom solid leather TCO (5" or 9") which offers
maximum stability of the subtalar and midtarsal joint with complete
immobilization at the ankle. This device controls motion in frontal,
sagittal and transverse planes.
Charcot Joint-Destructive joint dis-ease caused by diminished
proprio-ceptive sensation, with gradual destruction of joints of the foot
and ankle.
A custom solid Leather TCO ( 9") which offers maximum stability of the
subtalar and midtarsal joint with complete immobilization at the foot and
ankle. This device controls motion in frontal, sagittal and trans-verse
planes.
Degenerative Joint Disease-(DJD) is a degeneration of the joint surface of
the joints of the foot and ankle resulting from wear and tear over many
years.
A custom solid Leather TCO (9") which offers maximum stability of the
subtalar and midtarsal joint with complete immobilization at the foot and
ankle. This device controls motion in frontal, sagittal and trans-verse
planes.
Drop Foot-Weak or absent ankle dorsiflexors.
A custom LAST AFO which compen-sates for weak dorsiflexors by resist-ing
plantarflexion at heel strike and during swing phase. Designs can vary
depending upon types of ankle joint or posterior trimline variations needed
to control frontal and transverse plane motions.
Proper coding for success
(Disclaimer: The codes contained herein are not the official position or
endorse-ment of any organization or company. They are offered as a
suggestion based on upon input from previous customers and professionals.)
To properly bill , you need to prop-erly code.
- If you plan on billing any insurance carrier other than Medicare, you do
not need a DMERC number.
- If you plan on billing Medicare, you need a DMERC number. DMERC Supplier
number can be requested by calling 1-866-238-9652. They will ask for your
TAX ID # and mail you an application to you.
Proper L-Codes for DCOs and TCOs
When coding for an AFO you must use the correct code.
DCO Codes
- L1970-AFO, Plastic, molded to patient model with ankle joints.
- L2820-Addition to lower extremity, soft interface, below knee
TCO Codes
- L1940-AFO, Plastic, Molded to patient model
- L2820-Addition to lower extremity, soft interface, below knee
- L2280-Addition to lower extremity, molded inner boot
- L2275-Addition to lower extremity, varus/valgus correction plastic
modi-fication.
Posterior Solid AFO-L1960-AFO, Plastic, molded to patient model, posterior
leaf design
- When billing, the place of service is 12 (home), to indicate "where" the
brace will be used.
- In box 11 of the HCFA form type the word "No". Indicate RT or LT on the L
code, for example L1970RT
- Proper ICD9 Codes must be used for example Tendon Rupture 727.68
Langer strives to be your resource for ankle foot orthoses. We offer free
consultations services with our board certified podiatric medical advisors
and certified orthotists, all with over twenty years of clinical experience.
Steven Goldstein is a certified orthotist and is Executive Vice President
of Business Development for Langer Inc. He can be reached at
<mailto:sgoldstein@langerinc.com> sgoldstein@langerinc.com or by calling
631-274-8704
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Langer offers an the Langer Ankle Stabilizer Starter kit for just $79. It
includes a LAST Manual to help with prescribing and coding, STS casting
socks and instructional brochure and tape, measuring and fitting supplies.
Just call (800) 800.645.5520, ext. 149 or email
<mailto:bwolfe@langerinc.com> bwolfe@langerinc.com
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