Instructional Concurrent Session II
A Guide to Orthotics Billing and Reimbursement
Orthosis denials and recoupments for Medicare beneficiaries have increased since 2019. Analysis of data collected by APTA, AOTA and ASHT to demonstrate the scope of the issue and communication with CHT’s confirmed the problem but also revealed coding confusion on the part of therapists. This session will review correct coding for custom fabricated and prefabricated orthoses, repairs and replacements and replacement eligibility. The history of the adoption of the Reasonable, Useful Lifetime and Minimum Lifetime Requirement for Medicare reimbursable DMEPOS and the application of “same or similar” denials will be explained along with the multi-organizational effort to update the Reasonable Useful Lifetime standard. Opportunities for education and advocacy will also be reviewed.
- Identify the correct coding applicable to upper extremity orthoses.
- Describe the process for determining if an ABN should be issued prior to providing an UE orthosis for a Medicare beneficiary
- List the conditions required for reimbursable orthosis replacements.
- Discriminate between orthosis management codes and orthosis repair codes.
- Identify resources for billing orthoses
Conservative Management of Peri-scapular Nerve Palsies
Management of nerve palsies affecting the shoulder and periscapular musculature is a daunting task. Such palsies can present in isolation or in combination following a brachial neuritis (Parsonage Turner syndrome), trauma, dislocation or as an iatrogenic injury. Based on the level of nerve injury the recovery period can last as much as three years. There is paucity of information in the literature that adequately describes the vital role the therapist may have in management of both non-surgical and surgical patients who present with such palsies. The purpose of this course is to present a comprehensive rehabilitation model for patients with long thoracic and spinal accessary nerve injuries. Topics to be covered include review of pertinent anatomy and patho-kinesiology, evaluation skills, pain management, key concepts for the development of appropriate and progressive exercise programs. Post-operative management of primary repairs, grafting and nerve transfers will also be covered. If time permits, a brief lab period will be offered.
- Attendees will be able to describe or demonstrate appropriate testing to assess for weakness and recovery of trapezius and serrates anterior muscle function.
- Attendees will be able to discuss and implement a pain management plan for patients with periscapular nerve palsies
- Attendees will be able to describe a progressive exercise plan for post op patients who have undergone repairs or nerve transfers
Optimizing Patient Outcomes After Traumatic Elbow Injuries
Elbow fractures and dislocations may have profound effects on upper extremity function. Common complications that may limit functional recovery include persistent pain and joint stiffness. Peripheral nerve injuries are frequently overlooked with elbow trauma and may contribute to persistent pain, movement impairment, and significant functional limitations if not identified and promptly managed. The architecture of the elbow makes the elbow inherently stable, but elbow trauma rehabilitation is challenging due to the low prevalence of elbow fractures and dislocations. Evidence-informed guidelines for hand therapy management are limited due to the paucity of scholarly work and low prevalence. Using a case series approach, this session will provide recommendations, opportunities for discussion and problem solving for comprehensive client management including clinical examination and targeted interventions to achieve optimal patient outcomes.
- Describe anatomy and biomechanics of the elbow/forearm complex including the course of the peripheral nerves vulnerable with traumatic elbow injuries.
- Employ clinical examination techniques to identify peripheral nerve injuries and causes of movement dysfunction.
- Formulate a plan of care with targeted interventions to management post-traumatic stiffness of the elbow to restore a functional arc of motion.
- Formulate a plan of care to address other factors associated with movement dysfunction to optimize functional outcomes.
The Transition Phase for Returning to Golf
This lab based presentation involves demonstration, discussion and practice of evaluation and treatment skills that go beyond managing the golfer's UE injury. Concepts of the many components that are helpful for golf readiness are presented as a platform for looking beyond the upper extremity injury when planning a safe and staged return to golf. Basic biomechanics of the sport are reviewed to enhance the comprehensive treatment approach for return to sport.
- Demonstrate three evaluation procedures that relate to the whole body mechanics necessary for golf
- Demonstrate three treatment procedures for the upper quarter and core musculature that enhance return to golf
- Describe the basic essential biomechanics for the golf swing to apply to evaluation and treatment of injured golfers