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A checkout for orthotic/prosthetic use is a critical assessment conducted by a qualified therapist or technician. This procedure is specifically designed for patients who are either newly issued a device, have had their device modified, or have received a reissued device. Additionally, it is applicable for established patients who may have experienced a loss of function related to their device, developed pain or skin breakdown, or have sustained a fall. During this checkout, the device is thoroughly evaluated for its biomechanical function, ensuring that it meets established standards for quality, efficiency, and design. The assessment involves measuring the device against these standards to identify any necessary corrections or modifications that may be required to achieve proper fit and alignment. Furthermore, the checkout process includes a comprehensive evaluation of both the patient and the device to assess the extent and effectiveness of the patient's use of the device, as well as to evaluate the physical and psychological state of the individual. This thorough approach ensures that the patient receives optimal support and functionality from their orthotic or prosthetic device.
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The checkout for orthotic/prosthetic use is indicated for various circumstances that may affect the patient's interaction with their device. These indications include:
The procedure for the checkout of orthotic/prosthetic use involves several key steps to ensure a comprehensive assessment of both the patient and the device. These steps include:
After the checkout for orthotic/prosthetic use, patients are expected to follow specific post-procedure care instructions to ensure optimal use of their device. This may include adhering to any recommendations provided by the therapist or technician regarding the adjustment of the device, as well as monitoring for any signs of discomfort, pain, or skin breakdown. Patients should be encouraged to report any issues promptly to facilitate timely interventions. Additionally, the follow-up plan should be adhered to, ensuring that the patient returns for any scheduled assessments to evaluate the ongoing effectiveness of the device and make further adjustments if necessary. Overall, the goal of the post-procedure phase is to support the patient's recovery and enhance their quality of life through effective use of their orthotic or prosthetic device.
| Short Descr | C/O FOR ORTHOTIC/PROSTH USE | Medium Descr | CHECKOUT ORTHOTIC/PROSTHETIC ESTAB PT EA 15 MIN | Long Descr | Checkout for orthotic/prosthetic use, established patient, each 15 minutes | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 7 - Physical Therapy Service, for which Payment may not be Made | Multiple Procedures (51) | 5 - Special payment adjustment rules on the RVU practice expense component of multiple therapy service applies... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | Not applicable/unspecified. | CCS Clinical Classification | 215 - Other physical therapy and rehabilitation |
| 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case |
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| 2017-12-31 | Deleted | Code deleted, use 97763. |
| 2011-01-01 | Changed | Medium description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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