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| Extension/Flexion Contracture Treatment Devices – E1800-E1841 Devices billed with codes E1800 – E1841 are used to treat flexion and/or extension contractures of various joints. Products described by these codes include but are not limited to Dynasplint systems, Pro-Glide Dynamic Splints (DeRoyal), Advance Dynamic ROM Splints (EMPI), Joint Active Systems devices, Comfy or Comfyprene Spring Loaded Goniometer devices (Lenjoy Medical). Refer to the DMECS Product Classification List on the PDAC web site or contact the PDAC for questions concerning the correct coding of devices that are not listed in DMECS. These devices are typically used to treat contractures that are related to recent acute events, including but not limited to, surgery, fracture or other trauma, or stroke and that have not responded to physical therapy and other treatments. They are not usually used to treat contractures related to arthritis or other chronic conditions. If these claims are developed at the time of initial determination or as part of a pre-pay or post-pay audit or are submitted as an appeal, the following documentation should be provided: Detailed written order, signed and dated by the physician, includingBeneficiary nameProduct name or narrative description of the deviceFrequency and duration of wear time (for dates of service on or after 10/1/09)Estimated length of needPhysician signature and signature date entered by the physician (signature and date stamps are not acceptable)Start date of the order, if signed after deliveryMedical records including documentation of:Primary condition, including the date of the acute event relating to use of the devicePhysical therapy or other treatment of the contracture prior to use of the deviceFor initial month claims, quantitative measurements of the range of motion of the joint within 1 week prior to the initial date of service plus earlier measurements which document response to prior treatmentFor subsequent rental months, range of motion measurement prior to initiation of treatment and monthly measurements thereafterOther records specifically requested in a development letter The medical records could be from a physician or other Medicare provider – e.g., physical therapist (PT) or occupational therapist (OT) – who is involved in the care of the patient and has no financial relationship with the supplier. Medical records may include, as appropriate, physician office notes, PT or OT notes, hospital notes or discharge summary, operative reports, x-ray or other imaging reports, etc. It is important to note that forms developed by the supplier are not sufficient documentation, even if completed and signed by the physician. These devices are covered under the durable medical equipment benefit and therefore are not eligible for payment for patients in a nursing facility even if the nursing home stay is long term/permanent and is being paid by the patient, Medicaid, or other payer. |
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