10/27/2016    Paul Kesselman DPM

Dispensing Surgical Shoes (Adam Siegel, DPM)

Surgical shoes are a non-issue and are a cash
product which is not covered by Medicare and
almost every third-party payer. Therefore,
there is absolutely no reason why you could not
dispense this item to your patient prior to
surgery. The profit on these is slim with most
providers I speak with not charging more than
$30 and the lowest cost I've seen being about
$5, only leaving at most usually a $25 profit.

When it comes to CAM walkers, however, that is
entirely another story. One must also divide
this discussion into non Medicare and
Medicare. Most third party non Medicare payers
will only pay for such an item when there is
medical necessity, however because each payer
operates under its own rules, one should check
with your patients specific carrier and policy
regarding prior authorization requirements and
other regulations regarding dispensing
(including pre-operative).

As for DME Medicare, this was actually an issue
recently brought up in Codingline by a practice
administrator who attended the same Noridian
DME meeting (which I had attended). This
subject was initiated by an orthotist who was
confused about the 48 hour rule, which allows
in- patient dispensing post operatively but
only within 48 hours prior to discharge. This
is usually not the situation for most
podiatrists, who are performing surgery in the
ASU or free standing ASC.

Under Medicare, there are two issues here: The
first hurdle is that the supplier must be
credentialed at the facility where the
dispensing and the medical records are kept.
Putting a POS =12 with your office as the
facility where the service(s) were rendered
could be considered an abusive practice
resulting in fines, violations, etc.

The second hurdle is that Medicare requires the
patient have a deformity and a medical
necessity to be substantiated prior to or at
the time of the dispensing and not at some time
in the future post-operatively. One would be
hard pressed to substantiate the medical
necessity for a CAM boot prior to surgery,
despite the pre-operative deformity.

Another reason for not dispensing at the ASU or
ASC is to avoid making enemies with their
administration. They too are on a tight budget
and would also like to share in the additional
revenue. Dispensing an item from their
facility, from which you will profit, is like
taking your food to a restaurant and asking
them to cook it for you.

Another concern for preoperative dispensing as
a whole would be to have an action plan in case
the surgery is postponed or cancelled.

The best suggestion (written by this author and
others in Codingline) is to place the patient
in a posterior splint, bi-valved cast, etc.
which is a low budget item to the facility and
is part of their prospective payment. What you
do in your office is really not their concern.
So simply dispensing the CAM boot at the first
dressing change in your office a few days post
operative is appropriate and would meet with
all the Medicare requirements and none of the
aforementioned concerns.

Lastly, this may be an unpopular answer, but it
is the safest approach which will keep you out
of trouble and still allow you to dispense
without avoiding all the land mines noted
above.

Paul Kesselman, DPM, Woodside, NY

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