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06/02/2016 Ron Werter, DPM
When capturing casting for orthotics, should you bill
a casting fee? (Robert Scott Steinberg, DPM)
Robert Scott Steinberg, DPM
The non-specific casting code CPT29799 is generally
meant for applying a cast, there is no mention in the
definition of applying a removable slipper cast for
taking an impression for a foot orthotic.
I do take issue with Dr. Steinberg's comments about
not billing for taking the impression if one is using
a scanner or foam box. I think he misunderstands the
purpose of technology. Any new technology, in this
case the scanner, is used to save operator time and
produce the same or better result. A 3-D scanner can
capture the same information that a plaster slipper
cast can, but by using an 3-D digital image instead
of a plaster impression. The technology converts the
reading into the same information that a cast can
give. I refer to Drs. L. Hubbin and P. Scherer's
paper on 3-D scanners (Evidence Based Medicine: Foot
Imagining for Custom Function Orthotics).
If I invest $3,000 for scanner technology so I don't
have to spend 20 minutes holding a wet piece of
plaster, isn't that what technology is about. When an
eye surgeon uses a laser for a cataract instead of a
knife does he get paid less. Should those of us who
are still using x-ray film instead of digital get
paid more because we are using our time to place the
film into the developer? Actually the opposite is
occurring in terms of digital x-rays. I also wonder
how the STS casting material that takes 60 seconds
instead of 8 minutes to set fits into this equation.
We are being paid for the expertise to take a proper
impression of the foot to send to the lab as a base
for the proper orthotic, not for the time it takes to
make the impression.
Obviously, any technology is operator dependent, if
you talk to orthotic lab owners, they will tell you
that some of their doctors still can't properly take
a plaster cast. Maybe those guys shouldn't bill for
casting.
If one uses a digital scanner, there is a learning
curve just as there is for plaster casting. One
should use the same criteria to take and examine the
digital scan as one does to make sure they are making
the proper plaster (or casting sock) impression.
As for foam boxes, certainly they should not be used
for functional orthotics, but I can't see taking a
plaster casting or even a digital scan for a severely
deformed rheumatoid arthritic foot. Is the expertise
of knowing when and how to take a semi weight bearing
impression in a foam box for an supportive
accommodative orthotic worth nothing compared to
taking a neutral position off weight bearing
impression.
If we can get paid for our expertise in taking the
impression, I see no reason for distinguishing which
gets billed for and which does not if what gets sent
to the lab is useful.
On the other hand, does anyone want to talk about
orthotics made from patients walking or standing on a
gait mat?
Ron Werter, DPM, New York, NY
Other messages in this thread:
07/12/2024
PODIATRIC SUPERGROUPS INN THE NEWS
DE Podiatrist Joins Brandywine Podiatry
Ginny Rishel Huang, DPM recently joined Brandywine Podiatry in Wilmington, Delaware. Brandywine Podiatry is the largest podiatry practice in the state of Delaware with 10 doctors and 7 offices.
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Dr. Ginny Huang |
Dr. Huang is a graduate of the College of Podiatric Medicine and Surgery at Des Moines University. She completed a podiatric residency at Crozer Health in Pennsylvania.
07/12/2024
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ASSOCIATE POSITION – MANHATTAN
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PME/GME APPROVED PODIATRY MULTIDISCIPLINARY FELLOWSHIP IN WOUND CARE AND HBOT
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WOUND CARE FELLOWSHIP - NEW YORK
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07/12/2024
APMA STATE COMPONENT NEWS
CA Podiatrist Installed as 2024-2025 CPMA President
Phong H. Le, DPM was installed as president of the California Podiatric Medical Association (CPMA) at the close of the Association’s Annual House of Delegates meeting this past June in Anaheim, CA.
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Dr. Phong Le |
Dr. Le is a board-certified podiatric surgeon who practices full-time in a mixed orthopedic group practice that he co-founded - Northern California Orthopaedic Associates in Elk Grove, CA. He is affiliated with Mercy General Hospital, Mercy Methodist Hospital, and Sutter Medical Center where he is Section Chair of Podiatry.
07/12/2024
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07/11/2024
YOU CAN'T MAKE THESE THINGS UP
RE: Outrageous Shoes of the Day
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Shoes of Star Wars, these are. |
Source: Submitted by Dr. David Alper
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