Medicare Knee Policy Quiz

1.

1 point

Claims for L1832, L1843, L1845, and L1850 will be covered and considered reasonable if an objective description of joint laxity is documented after examining the patient.

True

False

2.

1 point

When giving a patient a custom fabricated knee orthosis, L1846, as long as the conditions to require a custom fabricated orthosis are met (documented physical characteristic that renders a prefabricated orthosis unusable), Medicare will cover it.

False. The coverage criteria for the prefabricated orthosis codes L1843 and L1845 must also be met.

True. L1846 is its own code separate from L1843 and L1845 and requires a completely separate criteria for coverage.

3.

1 point

Which of the following must be true about physician information on a script or written order? Select all that apply.

A date is not required

The physician's name must be printed

Signature and date must be in the same color ink

A signature stamp is not allowed

4.

1 point

What conditions must be met for Medicare to cover a L1810 or a L1820?

Ambulatory patient

Patient has weakness or deformity of the knee

Patient's knee requires stabilization

All of the above

5.

1 point

Code L2755 describes an addition to a lower extremity orthosis composed of high strength and/or lightweight material, such as kevlar, carbon fiber or other laminated or impregnated composite material.

True

False

6.

1 point

Detailed documentation in the treating physician's records to support the medical necessity of a custom fabricated orthosis rather than a prefabricated orthosis is sufficient evidence for providing a patient with a custom fabricated orthosis.

True. The physician's records are considered legal documents and are the only documentation needed to support the medical necessity of a custom fabricated orthosis.

False. The physician's documentation must also be corroborated by the functional evaluation in the orthotist or prosthetist's records.

7.

1 point

Every script and written order must contain:

Product

Physician signature and date, in same color ink

Patient name

Printed physician name

All of the above

8.

1 point

In order to use a custom fabricated orthosis instead of a prefabricated orthosis, there must be a documented physical characteristic that requires its use. Which of the following meets the criteria for using a custom fabricated orthosis? Select all that apply.

Minimal muscle mass upon which to suspend an orthosis

Atypical thigh and calf dimensions due to obesity (BMI greater than or equal to 30kg/m2)

Disproportionate size of thigh and calf

Multiple diagnoses that require a conglomeration of two braces

Patient dislikes the style of the prefabricated braces

Deformity of the leg or knee that precludes fitting with a prefabricated orthosis

9.

1 point

Chondromalacia of patella (717.7) is an acceptable code for supplying a patient with a L1832.

True

False

10.

1 point

Claims for L1832, L1843, L1845, and L1850 will be covered if a subjective description of joint instability is documented.

True

False

11.

1 point

What is the useful lifetime of a L1832?

4 years

3 years

1 year

2 years

12.

1 point

What is the useful lifetime of a L1845?

3 years

1 year

4 years

2 years

13.

1 point

In addition to the patient having had a recent injury or surgical procedure on the knee, which of the following ICD-9 codes/diagnoses are acceptable for a L1830? Select all that apply.

Chondromalacia of the patella (717.7)

Sprains and strains of knee (844.0-844.2, 844.8)

Knee ligamentous disruption (717.81-717.9)

Multiple sclerosis (340)

14.

1 point

What one additional item should a script or written order for a L1846 contain?

Must state 'Custom' or the specific product name

Must have a meniscus tear diagnosis

Must list patient's height and weight

Must be written in black ink

15.

1 point

The following is an acceptable set of phrases to support knee instability and give a patient a L1843:

Ligamentous laxity and tenderness at the joint line

True

False

16.

1 point

In addition to the patient being ambulatory and having an objective description of a documented knee instability by examination, which of the following ICD-9 codes/diagnoses are acceptable for a L1843 and a L1845? Select all that apply.

Dislocation of knee (836.0-836.69)

Osteoarthritis (715.16, 715.26, 715.36, 715.96)

Fracture of patella (822.0, 822.1)

Meniscal cartilage derangement (717.0-717.5)

17.

1 point

In order for any item to be covered by Medicare, it must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

True

False

18.

1 point

For a L1830, L1832, L1843, or L1845 to be covered, in addition to the acceptable diagnoses, the beneficiary must also have had a recent injury to or a surgical procedure on the knee(s).

True

False

19.

1 point

In order to be covered by Medicare, a detailed written order (DWO) must be received by the supplier after a claim is submitted.

True

False

20.

1 point

The following is an acceptable set of phrases to support knee instability and give a patient a L1843:

Bone on bone and severe osetoarthritis

True

False

21.

1 point

A prescription is considered part of a patient's medical record.

True

False

22.

1 point

Which of the following conditions must be met to provide a patient with a L1846? Select all that apply.

Patient must be ambulatory

Patient must have one of the ICD-9 codes/diagnoses listed for L1843 and L1845

Patient's documented knee instability must be an objective description

Patient must have received a prior custom fabricated orthosis

Patient must have a documented physical characteristic that requires the use of a custom fabricated orthosis

Patient's documented knee instability must be a subjective description

Patient must have documented knee instability by examination

Patient must have had a recent injury or surgical procedure on the knee

Patient must have a written order specifying a custom fabricated brace

23.

1 point

Can a positive McMurray's test be used to support knee instability?

The McMurray's test cannot be used alone to support knee instability.

The McMurray's test alone is sufficient to support knee instability.

The McMurray's test does not measure knee stability.

24.

1 point

Which of the following diagnoses are unacceptable for patients receiving L1810 & L1820? Select all that apply.

Fall

Sprain

Contusion

Pain

25.

1 point

Medical information included on the prescription is sufficient when intending to demonstrate compliance with coverage criteria.

True

False