Orthopedic Coding Alert

Question: I have applied to a Medicare supplier for items like CAM walkers, case boots, bunion shoes, etc. Other administrators and our attorney have told me that this is not a good idea and that it could cause investigation. What is the problem?

Ohio Subscriber

Answer: Historically, most orthopedists dispensed many durable medical equipment (DME) items, such as braces, orthotics, splints, crutches, etc., from their offices and billed the patients insurance carrier. However, HFCA and the office of the inspector general (OIG) have placed ever-increasing scrutiny on DME in recent years because of much fraudulent billing for these items. Many orthopedic practices have ceased dispensing these items.

Reimbursement has come into play also, as many HMOs contract with specific DME vendors and will not reimburse physicians for these items.