O-Knee Orthoses

Description:

L1810-Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

 

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M22.40-Chondromalacia patellae, unspecified knee, M76.50-Patellar tendinitis, unspecified knee, M22.2-Patellofemoral disorders
Manufacturer: Corflex Knee Sleeve With Hinge, Breg® Lateral Stabilizer With Hinge Soft Knee Brace, Hely & Weber Axis Hinged Knee Sleeve, DonJoy® REACTION WEB Knee Brace
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1812-Knee orthosis, elastic with joints, prefabricated, off-the-shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M22.40-Chondromalacia patellae, unspecified knee, M76.50-Patellar tendinitis, unspecified knee, M22.2-Patellofemoral disorders
Manufacturer: Corflex Knee Sleeve With Hinge, Breg® Lateral Stabilizer With Hinge Soft Knee Brace, Hely & Weber Axis Hinged Knee Sleeve, DonJoy® REACTION WEB Knee Brace
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1820-Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, includes fitting and adjustment

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M22.40-Chondromalacia patellae, unspecified knee, M76.50-Patellar tendinitis, unspecified knee, M22.2-Patellofemoral disorders
Manufacturer: Bledsoe™ Hinged Knee FT, Ossur® Neoprene Wraparound Hinged Knee Suppor, Corflex CoolTex Anterior Closure Knee Wrap With Hinge
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1830-Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: S82.9 Unspecified fracture of lower leg
Manufacturer: Rhino Knee Immobilizer, DeRoyal® Sized Tietex Knee Immobilizer, Ossur Form Fit® Knee Immobilizer
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1831-Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M24.569 Contracture, unspecified knee
Manufacturer: OCSI DynaPro™ Flex Knee, RCAI Premier Static Adjustable KCO, Anatomical Concepts KMO™ Knee Orthosis
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1832-Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M23 Internal derangement of knee, S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter
Manufacturer: Bledsoe™ Crossover FC, Bledsoe™ Crossover ROM, Ossur® Innovator DLX®+, Bledsoe™ G3
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1833-Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M23 Internal derangement of knee, S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter
Manufacturer: Breg® Quick Fit EPO Post-Op Knee Brace, BREG T-Scope 0881X , Breg Shortrunner Soft Knee Brace, DJO Playmaker II
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1834-Knee orthosis, without knee joint, rigid, custom fabricate

The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:

L2755- high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

L2795- Knee control full kneecap

L2800- knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only

L2810- Knee control condylar pad

L2820- soft interface for molded plastic, below knee section

L2830- soft interface for molded plastic, above knee section

L2999- Lower extremity orthoses, not otherwise specified

A4466- Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each

Justification for a Custom KO:

The patient could not be fit with a prefabricated brace due to abnormal anatomy, would not provide sufficient control of the lower extremity, etc. 
The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than 6 months), or There is a need to control the knee in more than one plane
The patient has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury
The patient has a healing fracture, which lacks normal anatomical integrity or anthropometric proportions.

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Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1836-Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M24.569 Contracture, unspecified knee
Manufacturer: Lenjoy Comfy™ Knee Orthosis, Pediatric Comfy Knee Orthosis, KAFO Upper Component Knee Extension KO
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1840-Knee orthosis, derotation, medial-lateral, anterior cruciate ligament, custom fabricated

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Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1843-Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M17.10 Unilateral primary osteoarthritis, unspecified knee, M17.0 Bilateral primary osteoarthritis of knee, M17.5 Other unilateral secondary osteoarthritis of knee, M17.4 Other bilateral secondary osteoarthritis of knee
Manufacturer: Townsend Design UniReliever Knee Brace, Ossur® Unloader One® With SmartDosing™, Breg® Thruster RLF
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1844-Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated

The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:

L2385- Straight knee joint heavy duty 

L2390- Offset knee joint each

L2395- Offset knee joint heavy duty

L2397- Addition to lower extremity orthosis, suspension sleeve 

L2405- Knee joint drop lock each joint

L2415- Knee joint cam lock each joint

L2425- knee joint, disc or dial lock for adjustable knee flexion, each joint

L2430- knee joint, ratchet lock for active and progressive knee extension, each joint

L2492- knee joint, lift loop for drop lock ring

L2750- plating chrome or nickel, per bar

L2755- high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

L2780- non-corrosive finish, per bar

L2785- Drop lock retainer each

L2795- Knee control full kneecap

L2800- knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only

L2810- Knee control condylar pad

L2820- soft interface for molded plastic, below knee section

L2830- soft interface for molded plastic, above knee section

L2861- knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

L2999- Lower extremity orthoses, not otherwise specified

A4466- Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each

Justification for a Custom KO:

The patient could not be fit with a prefabricated brace due to abnormal anatomy, would not provide sufficient control of the lower extremity, etc. 
The condition necessitating the orthosis is expected to be permanent or of longstanding duration (more than 6 months), or There is a need to control the knee in more than one plane
The patient has a documented neurological, circulatory, or orthopedic status that requires custom fabricating over a model to prevent tissue injury
The patient has a healing fracture, which lacks normal anatomical integrity or anthropometric proportions.

ICD10 Code:: M17.10 Unilateral primary osteoarthritis, unspecified knee, M17.0 Bilateral primary osteoarthritis of knee, M17.5 Other unilateral secondary osteoarthritis of knee, M17.4 Other bilateral secondary osteoarthritis of knee
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Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1845-Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: m17.10 Unilateral primary osteoarthritis, unspecified knee, M17.0 Bilateral primary osteoarthritis of knee, S83.50 Sprain of unspecified cruciate ligament of knee, S83.40 Sprain of unspecified collateral ligament of knee
Manufacturer: Ossur® CTi®, Breg® Z-13, Breg® Z-12 D Knee Brace, Fusion OA Plus Knee Brace BREG, Ossur Flex OTS Knee Brace
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1846-Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated

The following add-on codes may be used for this base code (only code for what you use). Subject to Coverage Criteria:

L2385- Straight knee joint heavy duty

L2390- Offset knee joint each

L2395- Offset knee joint heavy duty

L2397- Addition to lower extremity orthosis, suspension sleeve

L2405- Knee joint drop lock each joint

L2415- Knee joint cam lock each joint

L2425- knee joint, disc or dial lock for adjustable knee flexion, each joint

L2430- knee joint, ratchet lock for active and progressive knee extension, each joint

L2492- knee joint, lift loop for drop lock ring

L2750- plating chrome or nickel, per bar

L2755- high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

L2780- non-corrosive finish, per bar

L2785- Drop lock retainer each

L2795- Knee control full kneecap

L2800- knee control, knee cap, medial or lateral pull, for use with custom fabricated orthosis only

L2810- Knee control condylar pad

L2820- soft interface for molded plastic, below knee section

L2830- soft interface for molded plastic, above knee section

L2861- knee or ankle, concentric adjustable torsion style mechanism for custom fabricated orthotics only, each

L2999- Lower extremity orthoses, not otherwise specified

A4466- Garment, belt, sleeve or other covering, elastic or similar stretchable material, any type, each

ICD10 Code:: M17.10 Unilateral primary osteoarthritis, unspecified knee, M17.0 Bilateral primary osteoarthritis of knee, S83.50 Sprain of unspecified cruciate ligament of knee, S83.40 Sprain of unspecified collateral ligament of knee
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Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1847-Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: I63.9-Stroke, M24.56 Contracture knee
Manufacturer: DeRoyal® Pucci® Air Inflatable Knee Splint, KNEE ORTHOSIS INFLATABLE ALIMED
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1848-Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: I63.9-Stroke, M24.56 Contracture knee
Manufacturer: DeRoyal® Pucci® Air Inflatable Knee Splint, KNEE ORTHOSIS INFLATABLE ALIMED
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1850-Knee orthosis, swedish type, prefabricated, off-the-shelf

We do not suggest billing add-on codes with the base code above. 

ICD10 Code:: M21.869-Other specified acquired deformities of unspecified lower leg
Manufacturer: OCSI OrthoPro™ HyperEX™ Knee, Swedish Knee Cage – Standard, Allard CHECK™ Comfortable Hyper-Extension Control Knee
Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.
Description:

L1860-Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)
 May be a covered L-code for  a patient that is ambulatory and presents with knee instability secondary to genu recurvatum

ICD10 Code:: M21.869-Other specified acquired deformities of unspecified lower leg
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Disclaimer: Responsibility for accurate coding lies solely with the clinician treating the patient. OandP Academy assumes no responsibility or liability for the provider’s coding decisions. OandP Academy coding suggestions rest on its best judgment and are subject to revision based on additional information or changes in the alpha-numeric system. Ultimately it is your responsibility to code appropriately. Code using this tool at your own risk. OandP Academy suggest that there is documentation of what is being provided to the patient and that services furnished are clinically justified.