Coding of Bledsoe Bunion Boot

[Questions]

Medicare and most third party payers do not allow the use of L2820 when billed in conjunction to the Bledsoe Bunion Boot or any pneumatic or non-pneumatic walking boot.

Primarily, the 2008 definition of L4360 is: "Walking boot, pneumatic, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment."

This indicates that interface material may or may not be present. Certainly, this definition alone would preclude of any additional coding for added materials, including joints or soft tissue interface materials.

Secondly, within the definition of L2820 is the phrase "molded plastic." A L4360 device is a pre-fabricated device which is not molded to the patient's foot, leg, etc. The use of L2820 should be restricted to those devices which are custom fabricated or custom fitted. Since the Bledsoe device would not qualify as either, this would preclude the use of any additional add-on codes.

Thirdly, the 2009 HCPCS Code Set Update contains a slight change in the L4360 definition to include the verbiage "vacuum," and reads:

"Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, includes fitting and adjustment."

And finally, it should be noted that the Bledsoe company site suggests using only L4360.

So, to answer your question, no, the insert is not an L2820, and, no, you cannot bill it with a pre-fabricated pneumatic walking boot.

Paul Kesselman, DPM
Woodside, NY