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Next Step in Electrical Stimulation Orthoses PPageage 4 Navigating the O&P Insurance Maze atients receiving a prosthetic or orthotic device for the first Prosthetic and orthotic coverage definitions in many policies may time may experience confusion and frustration at the often be vague and thus open to interpretation as to whether requested Plengthy and mysterious process of obtaining insur- items or services are “medically necessary.” Coverage is also gener- ance approval for the prescription their doctor has writ- ally limited to the item or service deemed the “least ten for them. The costly most functional alternative,” also often unde- In what some remember as the “good old days” of fined. As a result, we are many times required to justify private indemnity insurance, delivery of orthoses and Financial each of the components and services we intend to pro- prosthetic limbs was seldom delayed by third-party vide with numerous back-and-forth communications intervention. The insurance company paid for the Side between our staff and the case manager...and the clock device the doctor prescribed minus any deductibles keeps ticking. Prosthetics • Orthopedic Bracing • Seating & Mobility No. 7 specified in the policy. That was then. Today, we operate under a Eventually, we are usually able to provide a satisfactory prosthetic whole new “alphabet soup” of insurance plans with different and or orthotic solution for the patient’s needs. It’s an imperfect system, detailed rules and requirements. but we strive to help all concerned navigate the O&P insurance maze. The net result is that doctors and prosthetist-orthotists no longer If you have a specific question about Medicare or private insur- A ‘Stimulating’ Orthotics Advance fully determine what prosthetic or orthotic device a patient will ance coverage, contact our office. receive under insurance coverage...the ultimate decision-maker in new modality has taken up residence in the orthotics disci- Electrical stimulation for standing and many cases has become the insurance carrier. Particularly in situa- New AAOS Orthotics Atlas Arrives pline, broadening rehabilitation horizons for many patients ambulation may be used in a hybrid system in tions involving newer high-tech componentry, the prescription is The fourth edition of the AAOS Atlas of Orthoses and Awith neuromuscular dysfunction and/or chronic pain. This conjunction with traditional mechanical sup- more of a recommendation to be submitted up the line for approval Assistive Devices is now available. Working in conjunction with technology amplifies, and in some cases replaces, conventional port, such as an AFO, walker, or elbow canes. (unless the payment is coming from private funds). Obtaining that the American Association of Orthopaedic Surgeons (AAOS), orthotic management with neuromuscular electrical stimulation However, in new devices developed for man- approval is not always easy or expeditious. authors John Hsu, M.D.; John Michael, CPO; and John Fisk, (NMES) to offer restored function, pain relief and other benefits to aging basic foot drop the stimulation unit may When we receive a referral for orthotic or prosthetic services, we M.D. have significantly revised the Atlas con- patients with paralysis or other deficit secondary to stroke, head or be used without auxiliary support. initially verify the patient’s coverage, normally a quick and simple tent and added a helpful two-color format. spinal cord injury, cerebral palsy, multiple sclerosis, or other condi- Contraindications for using NMES include process. Then, after an initial patient evaluation based on the doc- The 672-page edition contains new chap- tions producing upper motor neuron pathway disruption. a history of cardiac or respiratory problems, tor’s prescription, we compile an authorization request to the insurer ters on cranial orthoses and orthoses for per- In many central nervous system disorders, although seizure disorders, long bone for services we intend to provide, using a series of “L-codes” estab- sons with post-polio syndromes. Each chapter the brain or spinal cord is damaged, the peripheral stress fractures, osteoporosis or lished by the Centers for Medicare & Medicaid Services (CMS) and includes sidebars with personal perspectives nerves connecting the cord to the muscles remain Orthotics joint disease; irreversible contrac- WalkAide® FES used by all U.S. payers and providers. Generally each insurer will and tips from well-known physiatrists. viable and thus responsive to electrical stimulation. tures; Guillain-Barré Syndrome; system for addressing follow CMS coverage parameters, amplified by its own policy limi- NMES and its cousins FES (functional electrical Today pregnancy; skin disease or a frac- Existing, revised chapters cover orthotic foot drop tations and exclusions. stimulation) and TENS transcutaneous electrical ture/dislocation near the stimulation prescription, strength and materials, normal and pathologic gait, Courtesy Innovative While we can usually fabricate and fit, repair or enhance a brace and biomechanics of the spine, upper limb, hand, and lower limb. nerve stimulation) are not new. However, recent improvements in site; morbid obesity; recent surgery; and use of Neurotronics Inc. or replacement limb in a timely fashion, we normally cannot begin The chapters on spinal and upper- and lower-limb orthoses miniaturizing and packaging componentry now allow stimulation certain types of pacemakers or implants. the process until we can be certain the services will be reimbursed include new evidence-based recommendations for prescription. devices to be worn effectively and comfortably on a patient’s ana- Articles on pages 2 and 3 discuss three products producing by the insurer. The review process varies by insurance company and The revised Atlas was recently priced at $159.20 at tomy, much like a mechanical orthosis. excellent results in the management of foot drop and a unique sometimes results in a denial (which we may appeal) or a request Amazon.com. These components, variously termed neuroprosthetic or myo- approach to securely surface electrodes on almost any part of the for additional information...and time passes. orthotic devices, are being successfully applied to accomplish many body. We welcome you inquiries and referrals. traditional orthotic objectives, notably to... • replicate normal muscle function • enable standing and ambulation High-Tech O&P Offering a Full Line of Patient Aids and Safety Items • alleviate chronic pain Orthopedic Appliance Company utilizes many of today’s latest orthotic and prosthetic technologies, from our in-house When it comes to walking aids, bath safety • reduce spasticity • provide therapeutic exercise CAD/CAM system and multi-axis computerized carver to the and personal care products, we at Orthopedic • improve circulation and organ latest in microprocessor-controlled knee components, to enhance lifestyle outcomes for our patients. function Appliance Company are committed to meet- Several OAC patients are now using microprocessor knees such • increase joint range of motion as the C-Leg®, ranging from new amputees to patients who have ing the needs of your patients. Our carrying • re-educate voluntary muscles and been wearing older-style knee units for more 20 years. We are • reverse muscular atrophy. staff will fit and teach proper techniques for finding that these patients are experiencing significant increases in NMES directs small electrical im- using each device. their activities as their fatigue levels have decreased, allowing them pulses to excite the nerves that supply to be more active with day-to-day tasks for longer periods. The following are some but not all of the paralyzed muscles. Electrodes may be Whatever the situation, our staff has more experience than any Wearable therapy applied on the skin surface, inserted electrode garment other facility in Western North Carolina. Our expert prosthetists items we have in stock: deep into the muscle with a needle Courtesy Bioflex Electromedicine Inc. all received training at Northwestern University in Chicago and • Folding walkers • Rolling walkers (percutaneous) or surgically implanted. are board-certified by the American Board for Certification in • Crutches • Canes Today’s orthotic electrical stimulation strategies generally seek to Orthotics and Prosthetics. maximize the effectiveness of surface applications, which are gener- We welcome your inquiries and referrals. • Shower chairs • Transfer benches ally easier on the patient and thus advantageous in the long run. Page 2 Page 3 Foot Drop Devices Enhance FES Popularity ‘Wearable Therapy’ — Next Step In Electrical Stimulation Orthoses lthough functional electrical system consists of three distinct elements “connected” by wireless stimulation has been employed communication: ost of the buzz surrounding the incorporation of electrical therapy. The late actor in the care of neurologically 1. A leg cuff containing the stimulator component attaches to the stimulation technology into orthotic rehabilitation strategies Christopher Reeve, who A suffered a complete impaired patients for many years, the affected leg just below the knee. With the cuff properly in place, elec- Mhas centered around the portable technology has proceeded in relative trodes stimulate the peroneal nerve at the appropriate instant in the gait FES systems for foot drop described on spinal cord injury with obscurity in the orthotics-prosthetics cycle to contract the dorsiflexors and thereby lift the forefoot. page 2. However, the future of this mo- What’s resulting
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