I have found the best way to code this situation is the following:
First of all, the CAM boot walker cannot be dispensed and billed until the procedure is performed. After all, if you are dispensing a CAM boot walker in lieu of a cast, you would dispense post surgery, not pre-op.
Secondly, the CAM boot walker will be billed to the appropriate insurance carrier in the following manner:
If Medicare, It is billed to the appropriate DME Regional Contractor based upon the type of pneumatic CAM Walking boot dispensed and fitted:
L4360 (walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise) with a “KX” modifier and either an “RT” or “LT” appended or
L4361 (walking boot, pneumatic and/or vacuum, with or without interface material, prefabricated, off-the-shelf) with a “KX” modifier and either an “RT” or “LT” appended
If commercial insurance, it would be dispensed, fitted and billed based upon the medical policy of the insurance carrier. It is wise to pre-authorize/pre-certify:
L4360 either an “RT” or “LT” appended
L4361 either an “RT” or “LT” appended
Once again, the HCPCS Level II code to bill would be based upon the medical policy of the commercial insurance carrier.
Thirdly, I personally feel that the most appropriate diagnosis code(s) to use would be:
M20.11 (Hallux valgus [acquired], right foot); or
M20.12 (Hallux valgus [acquired], left foot)
Finally, I would then go to Block 19 on the CMS-1500 Claim Form or the electronic equivalent, the information Block/Box and I would print out: “For post surgical use.”
I receive reimbursement when I use this format. It should help you to achieve the same. This is my opinion.
Michael G. Warshaw, DPM, CPC, DABMSP